Healthcare Provider Details

I. General information

NPI: 1881059582
Provider Name (Legal Business Name): CHIRO AT ORLANDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 SAND LAKE RD
ORLANDO FL
32809-7641
US

IV. Provider business mailing address

2328 10TH AVE N STE 302
LAKE WORTH FL
33461-6612
US

V. Phone/Fax

Practice location:
  • Phone: 855-876-8648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: NICK MATTEO
Title or Position: CFO
Credential:
Phone: 561-318-4430