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General NPI Number Information
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NPI Number | 1225433741
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Entity Type | Organization
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Legal Business Name | LAKE NONA SPINE CENTER, INC.
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 10979 SAVANNAH LANDING CIR
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City | ORLANDO
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State | FL
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Zip | 32832-5104
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Country | US
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Telephone | 321-299-5266
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Fax | 407-403-6550
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Provider Business Mailing Address
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Address Line | 10979 SAVANNAH LANDING CIR
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City | ORLANDO
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State | FL
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Zip | 32832-5104
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Country | US
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Telephone | 321-299-5266
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Fax | 407-403-6550
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Authorized Official
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Title or Position | PCEO
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Name | DR. CHRISTOPHER MATTHEW VANN
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Credential | D.C.
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Telephone | 321-299-5266
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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 | CH10812
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License Number State | FL
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