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General NPI Number Information
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NPI Number | 1023662541
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Entity Type | Organization
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Legal Business Name | AWAKEN CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 5200 NW 43RD ST STE 507
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City | GAINESVILLE
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State | FL
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Zip | 32606-4524
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Country | US
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Telephone | 352-448-1402
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 NW 43RD ST STE 507
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City | GAINESVILLE
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State | FL
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Zip | 32606-4524
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Country | US
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Telephone | 352-448-1402
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Fax |
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Authorized Official
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Title or Position | OWNER / DOCTOR OF CHIROPRACTIC
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Name | DR. SHANE A SEMEGON
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Credential | DC
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Telephone | 352-448-1402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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