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General NPI Number Information
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NPI Number | 1033568712
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Entity Type | Organization
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Legal Business Name | LEE VISTA CHIROPRACTIC
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 8288 LEE VISTA BLVD
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City | ORLANDO
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State | FL
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Zip | 32829-8071
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Country | US
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Telephone | 407-942-3258
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Fax | 407-942-3316
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Provider Business Mailing Address
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Address Line | 8288 LEE VISTA BLVD
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City | ORLANDO
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State | FL
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Zip | 32829-8071
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Country | US
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Telephone | 407-942-3258
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Fax | 407-942-3316
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Authorized Official
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Title or Position | OWNER
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Name | YANINA GENAO
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Credential | DC
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Telephone | 407-942-3258
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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 | CH10784
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License Number State | FL
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