Healthcare Provider Details

I. General information

NPI: 1013727569
Provider Name (Legal Business Name): DANIE DATULMA DC, FAKTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W ILLIANA ST
ORLANDO FL
32806-4455
US

IV. Provider business mailing address

5278 FLORIDA HOLLY DR
ORLANDO FL
32811-7928
US

V. Phone/Fax

Practice location:
  • Phone: 689-306-6133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH15157
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH15157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: