Healthcare Provider Details

I. General information

NPI: 1912179680
Provider Name (Legal Business Name): EXUM CHIROPRACTIC CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3541 EDGEWATER DR
ORLANDO FL
32804-2942
US

IV. Provider business mailing address

3541 EDGEWATER DR
ORLANDO FL
32804-2942
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-0038
  • Fax: 407-849-6084
Mailing address:
  • Phone: 407-423-0038
  • Fax: 407-849-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH5270
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT J FRITZ JR.
Title or Position: OWNER
Credential: D.C.
Phone: 407-423-0038