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General NPI Number Information
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NPI Number | 1528678679
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Entity Type | Organization
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Legal Business Name | TAMPA AVE CHIROPRACTIC CENTER, INC
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 764 S TAMPA AVE UNIT D
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City | ORLANDO
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State | FL
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Zip | 32805-3600
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Country | US
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Telephone | 407-839-1700
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Fax | 407-839-1209
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Provider Business Mailing Address
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Address Line | 764 S TAMPA AVE UNIT D
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City | ORLANDO
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State | FL
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Zip | 32805-3600
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Country | US
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Telephone | 407-839-1700
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Fax | 407-839-1209
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANFORD MARK
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Credential | DC
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Telephone | 407-802-7731
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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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