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General NPI Number Information
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NPI Number | 1609959600
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Entity Type | Organization
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Legal Business Name | LAKELAND SPORTS PERFORMANCE INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 5151 S LAKELAND DR SUITE 6
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City | LAKELAND
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State | FL
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Zip | 33813-2518
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Country | US
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Telephone | 863-646-3388
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Fax | 863-646-3380
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Provider Business Mailing Address
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Address Line | 5151 S LAKELAND DR SUITE 6
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City | LAKELAND
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State | FL
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Zip | 33813-2518
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Country | US
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Telephone | 863-646-3388
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Fax | 863-646-3380
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Authorized Official
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Title or Position | COO
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Name | DR. JOSEPH ALLEN ZAMZOW
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Credential | D.C.
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Telephone | 863-646-3388
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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 | CH8827
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License Number State | FL
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