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General NPI Number Information
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NPI Number | 1700155157
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Entity Type | Organization
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Legal Business Name | PALM SPRINGS INTEGRATIVE CENTER
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 685 PALM SPRINGS DR STE C1
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-7853
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Country | US
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Telephone | 407-332-7080
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Fax | 407-790-7806
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Provider Business Mailing Address
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Address Line | 685 PALM SPRINGS DR STE C1
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-7853
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Country | US
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Telephone | 407-332-7080
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Fax | 407-790-7806
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Authorized Official
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Title or Position | OWNER
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Name | YASER JIMENEZ-MUSSA
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Credential | CH
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Telephone | 407-332-7080
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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 | CH9295
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License Number State | FL
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