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General NPI Number Information
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NPI Number | 1386983567
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Entity Type | Organization
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Legal Business Name | LIVING WELL CHIROPRACTIC OF CENTRAL FLORIDA INC
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 4039 13TH ST
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6772
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Country | US
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Telephone | 407-957-1337
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Fax | 407-957-1848
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Provider Business Mailing Address
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Address Line | 4039 13TH ST
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6772
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Country | US
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Telephone | 407-957-1337
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Fax | 407-957-1848
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD M TAKANEN
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Credential | D.C.
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Telephone | 407-957-1337
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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 | CH10265
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License Number State | FL
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