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General NPI Number Information
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NPI Number | 1629778113
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Entity Type | Organization
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Legal Business Name | PRIME IMPACT CHIROPRACTIC, INC
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 100 E SYBELIA AVE STE 217
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City | MAITLAND
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State | FL
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Zip | 32751-4757
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Country | US
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Telephone | 407-887-6568
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Fax |
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Provider Business Mailing Address
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Address Line | 321 MISTY OAKS RUN
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City | CASSELBERRY
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State | FL
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Zip | 32707-2817
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Country | US
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Telephone | 954-415-5931
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | UCHE UKEAGU
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Credential | DC
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Telephone | 954-415-5931
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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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