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General NPI Number Information
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NPI Number | 1518784511
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Entity Type | Individual
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Provider Name | NATHANAEL ENNS PH.D, D.M.O. (BCDMO)
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Gender | Male
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 835 7TH ST STE 4 WITHIN OSBORNE FAMILY CHIROPRACTIC
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City | CLERMONT
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State | FL
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Zip | 34711-2190
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Country | US
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Telephone | 352-901-4513
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Fax |
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Provider Business Mailing Address
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Address Line | 225 BLUE CYPRESS DR
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City | GROVELAND
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State | FL
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Zip | 34736-8110
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Country | US
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Telephone | 352-888-4045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | LEHP1193
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License Number State | FL
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