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General NPI Number Information
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NPI Number | 1275819450
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Entity Type | Organization
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Legal Business Name | WINDERMERE CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 1805 MAGUIRE RD SUITE 135
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City | WINDERMERE
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State | FL
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Zip | 34786-7924
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Country | US
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Telephone | 407-217-6969
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 MAGUIRE RD SUITE 135
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City | WINDERMERE
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State | FL
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Zip | 34786-7924
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Country | US
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Telephone | 407-217-6969
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. STEPHEN RENICK JR.
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Credential | DC
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Telephone | 407-217-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | CH9701
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License Number State | FL
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