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General NPI Number Information
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NPI Number | 1285340927
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Entity Type | Organization
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Legal Business Name | SPINE SOLDIER CHIROPRACTIC CLINICS
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 190 VINING CT
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City | ORMOND BEACH
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State | FL
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Zip | 32176-6658
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Country | US
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Telephone | 386-673-3085
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Fax |
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Provider Business Mailing Address
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Address Line | 5 PINE LOOK PASS
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City | ORMOND BEACH
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State | FL
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Zip | 32174-2420
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Country | US
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Telephone | 386-405-4532
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS OYOLA
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Credential | DC
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Telephone | 386-405-4532
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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 |
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License Number State |
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