Healthcare Provider Details

I. General information

NPI: 1861708091
Provider Name (Legal Business Name): HEALTH AND WELLNESS CLINIC OF S ORLANDO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11364 S ORANGE BLOSSOM TRL
ORLANDO FL
32837-9426
US

IV. Provider business mailing address

11364 S ORANGE BLOSSOM TRL
ORLANDO FL
32837-9426
US

V. Phone/Fax

Practice location:
  • Phone: 407-240-0606
  • Fax: 407-240-0054
Mailing address:
  • Phone: 407-240-0606
  • Fax: 407-240-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberCH6162
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD T PFAFF
Title or Position: PRESIDENT
Credential: CHIROPRACTOR
Phone: 407-240-0606