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General NPI Number Information
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NPI Number | 1669645057
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Entity Type | Organization
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Legal Business Name | AMERICAN FAMILY & SPORTS CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 4649 CLYDE MORRIS BLVD UNIT 609
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City | PORT ORANGE
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State | FL
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Zip | 32129
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Country | US
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Telephone | 386-760-6150
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Fax | 386-788-1998
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Provider Business Mailing Address
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Address Line | 4649 CLYDE MORRIS BLVD UNIT 609
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City | PORT ORANGE
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State | FL
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Zip | 32129-3003
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Country | US
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Telephone | 386-760-6150
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Fax | 386-788-1998
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Authorized Official
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Title or Position | PRES
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Name | DR. ELIZABETH JANE HENNIGHAN
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Credential | D.C.
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Telephone | 386-760-6150
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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 | CH7773
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License Number State | FL
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