=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760927958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORTES CHIROPRACTIC CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2016
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1035 S FLORIDA AVE STE 200
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-500-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1035 S FLORIDA AVE STE 200
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-500-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSE L CORTES
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 201-857-4011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X010394
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------