Healthcare Provider Details

I. General information

NPI: 1972072726
Provider Name (Legal Business Name): GARY ROY BORAKS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6388 SILVER STAR RD STE #2A
ORLANDO FL
32818
US

IV. Provider business mailing address

6388 SILVER STAR RD, SUITE 2A
ORLANDO FL
32818
US

V. Phone/Fax

Practice location:
  • Phone: 407-253-1114
  • Fax: 407-253-1180
Mailing address:
  • Phone: 407-253-1114
  • Fax: 407-253-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: