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General NPI Number Information
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NPI Number | 1558540260
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Entity Type | Organization
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Legal Business Name | COLONIAL CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 1310 W COLONIAL DR STE 21-23
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City | ORLANDO
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State | FL
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Zip | 32804-7139
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Country | US
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Telephone | 407-849-0444
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Fax | 407-841-0037
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Provider Business Mailing Address
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Address Line | 1310 W COLONIAL DR STE 21-23
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City | ORLANDO
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State | FL
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Zip | 32804-7139
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Country | US
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Telephone | 407-849-0444
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Fax | 407-841-0037
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHONA SHERINIKA JOHNSON
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Credential |
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Telephone | 321-615-8977
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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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