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General NPI Number Information
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NPI Number | 1619157476
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Entity Type | Organization
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Legal Business Name | ADVANCE CHIROPRACTIC ADJUSTMENT
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 280 PATTERSON RD SUITE #2
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City | HAINES CITY
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State | FL
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Zip | 33844-6261
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Country | US
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Telephone | 863-421-8687
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Fax | 863-421-8670
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Provider Business Mailing Address
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Address Line | 280 PATTERSON RD SUITE #2
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City | HAINES CITY
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State | FL
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Zip | 33844-6261
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Country | US
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Telephone | 863-421-8687
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Fax | 863-421-8670
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Authorized Official
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Title or Position | OWNER
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Name | MS. ROSE MARLENE LUBIN
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Credential |
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Telephone | 863-421-8687
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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 | HCC7872
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License Number State | FL
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