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General NPI Number Information
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NPI Number | 1568273852
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Entity Type | Individual
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Provider Name | MAX JERENY SANTANA DC
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Gender | Male
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 520 W LAKE MARY BLVD STE 214
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City | SANFORD
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State | FL
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Zip | 32773-7424
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Country | US
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Telephone | 407-507-6058
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 TOMOKA TOWN CENTER DR APT 304
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5220
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Country | US
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Telephone | 787-231-1603
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 15336
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License Number State | FL
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