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General NPI Number Information
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NPI Number | 1518112341
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Entity Type | Organization
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Legal Business Name | HIGHLAND HEALTH & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 27615 US HIGHWAY 27 SUITE 109
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City | LEESBURG
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State | FL
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Zip | 34748-9396
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Country | US
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Telephone | 352-552-2181
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Fax |
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Provider Business Mailing Address
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Address Line | 6053 SPINNAKER LOOP
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City | LADY LAKE
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State | FL
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Zip | 32159-5922
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Country | US
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Telephone | 352-552-2181
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KEITH L BOSTAPH
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Credential | D.C.
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Telephone | 352-552-2181
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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 | CH8400
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License Number State | FL
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