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General NPI Number Information
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NPI Number | 1568776276
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC USA OF BUFFALO RIDGE INC
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 3614 WEDGEWOOD LN
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City | THE VILLAGES
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State | FL
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Zip | 32162-9318
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Country | US
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Telephone | 352-259-2225
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Fax | 352-259-4411
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Provider Business Mailing Address
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Address Line | 7668 S.W. 60TH AVENUE SUITE 500
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City | OCALA
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State | FL
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Zip | 34476-6404
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Country | US
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Telephone | 352-351-2872
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Fax | 352-351-0003
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. RENNY M EDELSON
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Credential | D.C.
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Telephone | 954-270-2884
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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 | CH5257
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License Number State | FL
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