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General NPI Number Information
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NPI Number | 1760937890
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Entity Type | Organization
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Legal Business Name | NONA FUNCTIONAL CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 9161 NARCOOSSEE RD # B208
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City | ORLANDO
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State | FL
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Zip | 32827-5764
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Country | US
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Telephone | 407-350-1594
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Fax | 321-396-7667
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Provider Business Mailing Address
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Address Line | 9161 NARCOOSSEE RD # B208
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City | ORLANDO
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State | FL
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Zip | 32827-5764
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Country | US
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Telephone | 407-350-1594
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Fax | 321-396-7667
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Authorized Official
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Title or Position | OWNER AND PHYSICIAN
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Name | RAIJOSE ROSA
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Credential | DC
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Telephone | 407-350-1594
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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 | CH11809
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License Number State | FL
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