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General NPI Number Information
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NPI Number | 1750495602
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Entity Type | Organization
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Legal Business Name | WINTER PARK COMPLEMENTARY MEDICINE
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 670 NORTH ORLANDO AVENUE SUITE #103
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 407-644-8197
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Fax | 407-644-8198
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Provider Business Mailing Address
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Address Line | 670 NORTH ORLANDO AVENUE SUITE #103
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 407-644-8197
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Fax | 407-644-8198
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. LESLIE S. MAFFIA
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Credential |
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Telephone | 407-644-8197
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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-7669
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License Number State | FL
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