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General NPI Number Information
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NPI Number | 1376729525
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Entity Type | Organization
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Legal Business Name | LAKE MARY CHIROPRACTIC CENTER PA
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 3240 W LAKE MARY BLVD STE. 1300
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City | LAKE MARY
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State | FL
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Zip | 32746-3583
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Country | US
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Telephone | 407-302-5161
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Fax |
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Provider Business Mailing Address
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Address Line | 3240 W LAKE MARY BLVD STE. 1300
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City | LAKE MARY
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State | FL
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Zip | 32746-3583
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Country | US
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Telephone | 407-302-5161
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL TOMA
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Credential | DC
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Telephone | 407-302-5161
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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 | CH7869
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License Number State | FL
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