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General NPI Number Information
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NPI Number | 1700496841
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Entity Type | Organization
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Legal Business Name | AVE K CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 308 AVENUE K SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4147
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Country | US
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Telephone | 863-229-5353
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Fax | 863-875-5877
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Provider Business Mailing Address
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Address Line | 1417 LITCHEM RD
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City | APOPKA
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State | FL
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Zip | 32712-3068
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Country | US
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Telephone | 407-802-7731
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SANFORD LAWRENCE MARK
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Credential | DC
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Telephone | 407-802-7731
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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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