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General NPI Number Information
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NPI Number | 1093311854
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Entity Type | Organization
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Legal Business Name | LUCHA CHIROPRACTIC QUALITY CENTER LLC
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 1320 LOUISIANA AVE STE D
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City | SAINT CLOUD
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State | FL
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Zip | 34769-4116
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Country | US
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Telephone | 407-593-8052
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Fax | 407-593-9014
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Provider Business Mailing Address
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Address Line | 1320 LOUISIANA AVE STE D
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City | SAINT CLOUD
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State | FL
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Zip | 34769-4116
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Country | US
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Telephone | 407-593-8052
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Fax | 407-593-9014
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. SAMUEL ELIAS LUCHA
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Credential | DC
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Telephone | 407-593-8052
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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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