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General NPI Number Information
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NPI Number | 1780006403
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Entity Type | Organization
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Legal Business Name | PURE CHIROPRACTIC & NATURAL HEALTH, PA
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 200 WAYMONT CT SUITE 126, UNIT #3
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City | LAKE MARY
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State | FL
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Zip | 32746-3413
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Country | US
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Telephone | 407-682-4454
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Fax | 407-682-3805
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Provider Business Mailing Address
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Address Line | 200 WAYMONT CT SUITE 126, UNIT #3
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City | LAKE MARY
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State | FL
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Zip | 32746-3413
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Country | US
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Telephone | 407-682-4454
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Fax | 407-682-3805
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NEAL WIEDER
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Credential |
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Telephone | 407-682-4454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | CH3063
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | CH3063
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | CH3063
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH3063
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License Number State | FL
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