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General NPI Number Information
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NPI Number | 1104149871
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Entity Type | Organization
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Legal Business Name | THE CHIROPRACTIC STUDIO AT LONGWOOD REHABILITATION
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 2629 W STATE ROAD 434
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City | LONGWOOD
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State | FL
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Zip | 32779-4878
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Country | US
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Telephone | 407-774-1716
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Fax | 407-774-9527
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Provider Business Mailing Address
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Address Line | 2629 W STATE ROAD 434
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City | LONGWOOD
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State | FL
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Zip | 32779-4878
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Country | US
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Telephone | 407-774-1716
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Fax | 407-774-9527
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Authorized Official
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Title or Position | OWNER
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Name | JAYNE KWIATKOWSKI
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Credential | DC
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Telephone | 202-365-8404
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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 | CH9417
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License Number State | FL
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