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General NPI Number Information
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NPI Number | 1396702130
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Entity Type | Organization
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Legal Business Name | REGIONAL CHIROPRACTIC GROUP PA
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 205 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32801-1203
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Country | US
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Telephone | 407-649-9699
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Fax | 407-649-8991
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Provider Business Mailing Address
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Address Line | 205 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32801-1203
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Country | US
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Telephone | 407-649-9699
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Fax | 407-649-8991
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Authorized Official
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Title or Position | OWNER
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Name | WAYNE C WOLFSON
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Credential | DC
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Telephone | 407-649-9699
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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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