Healthcare Provider Details

I. General information

NPI: 1033360441
Provider Name (Legal Business Name): FLORIDA PAIN MANAGEMENT INSTITUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 S CHICKASAW TRL
ORLANDO FL
32825-7801
US

IV. Provider business mailing address

539 S CHICKASAW TRL
ORLANDO FL
32825-7801
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-5439
  • Fax:
Mailing address:
  • Phone: 407-382-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH6418
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH9595
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME49756
License Number StateFL

VIII. Authorized Official

Name: DR. CHRISTOPHER C. RECKSIEDLER
Title or Position: MP
Credential: DC
Phone: 407-382-5439