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General NPI Number Information
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NPI Number | 1639233208
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Entity Type | Individual
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Provider Name | JOSE REINALDO HEREDIA D.C.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 6236 KINGSPOINTE PKWY STE 9
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City | ORLANDO
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State | FL
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Zip | 32819-6530
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Country | US
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Telephone | 407-240-9500
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Fax | 407-240-9500
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Provider Business Mailing Address
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Address Line | PO BOX 2358
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City | WINDERMERE
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State | FL
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Zip | 34786-2358
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Country | US
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Telephone | 407-240-9500
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Fax | 407-240-9501
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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 | CH 7044
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License Number State | FL
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