Healthcare Provider Details

I. General information

NPI: 1104131358
Provider Name (Legal Business Name): NIGHTLIGHT CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 MENENDEZ CT
ORLANDO FL
32801-3631
US

IV. Provider business mailing address

826 MENENDEZ CT
ORLANDO FL
32801-3631
US

V. Phone/Fax

Practice location:
  • Phone: 407-982-7733
  • Fax: 407-409-8360
Mailing address:
  • Phone: 407-982-7733
  • Fax: 407-409-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH9291
License Number StateFL

VIII. Authorized Official

Name: DR. ANDREW COBB MERRILL
Title or Position: OWNER
Credential: D.C.
Phone: 407-982-7733