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General NPI Number Information
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NPI Number | 1649558297
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Entity Type | Organization
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Legal Business Name | CHIROPRACTICUSA OF LEESBURG, INC
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 945 N 14TH ST
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City | LEESBURG
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State | FL
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Zip | 34748-3838
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Country | US
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Telephone | 954-581-1999
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Fax | 954-581-3970
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Provider Business Mailing Address
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Address Line | 300 NW 70TH AVE SUITE 100
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City | PLANTATION
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State | FL
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Zip | 33317-2384
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Country | US
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Telephone | 954-581-1999
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Fax | 954-581-3970
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. RENNY MITCHELL EDELSON
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Credential | D.C.
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Telephone | 954-581-1999
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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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