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General NPI Number Information
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NPI Number | 1275696247
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CENTER OF LAKELAND INC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 2390 GRIFFIN RD
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City | LAKELAND
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State | FL
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Zip | 33810-6760
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Country | US
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Telephone | 863-859-0335
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Fax | 863-859-0501
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Provider Business Mailing Address
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Address Line | 2390 GRIFFIN RD
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City | LAKELAND
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State | FL
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Zip | 33810-6760
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Country | US
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Telephone | 863-859-0335
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Fax | 863-859-0501
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN D JOHNSON
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Credential | DC
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Telephone | 863-859-0335
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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 | CH5721
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License Number State | FL
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