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General NPI Number Information
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NPI Number | 1104215706
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Entity Type | Organization
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Legal Business Name | ORLANDO SPINE AND WELLNESS CENTER
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 13802 LANDSTAR BLVD SUITE 107
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City | ORLANDO
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State | FL
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Zip | 32824-5500
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Country | US
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Telephone | 321-234-0124
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Fax | 321-280-1029
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Provider Business Mailing Address
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Address Line | 13802 LANDSTAR BLVD 107
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City | ORLANDO
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State | FL
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Zip | 32824-5500
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Country | US
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Telephone | 321-234-0124
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Fax | 321-280-1029
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL THORN BOWERMAN JR.
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Credential | D.C.
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Telephone | 407-446-6687
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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 | CH11337
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License Number State | FL
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