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General NPI Number Information
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NPI Number | 1114758034
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Entity Type | Individual
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Provider Name | ANDREW FLACK
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Gender | Male
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 13800 VETERANS WAY
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City | ORLANDO
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State | FL
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Zip | 32827-7401
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Country | US
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Telephone | 315-690-2495
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 LAKEMONT AVE UNIT 450
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City | ORLANDO
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State | FL
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Zip | 32814-6884
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Country | US
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Telephone | 315-690-2495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH15109
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License Number State | FL
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