Healthcare Provider Details

I. General information

NPI: 1609920792
Provider Name (Legal Business Name): ROFFLER CHIROPRACTIC CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 LAKE HOWELL RD
WINTER PARK FL
32792-1036
US

IV. Provider business mailing address

5502 LAKE HOWELL RD
WINTER PARK FL
32792-1036
US

V. Phone/Fax

Practice location:
  • Phone: 407-671-7974
  • Fax: 407-671-8855
Mailing address:
  • Phone: 407-671-7974
  • Fax: 407-671-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH2545
License Number StateFL

VIII. Authorized Official

Name: DR. REX W ROFFLER
Title or Position: PRESIDENT
Credential: DC
Phone: 407-671-7974