=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346454394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL FLORIDA MEDICAL & CHIROPRACTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6388 SILVER STAR RD SUITE 1D
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32818-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-702-3492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6388 SILVER STAR RD SUITE 1D
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32818-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-702-3492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | AMRIT HANS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-702-3492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | HCC6482
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------