=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780695619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH ANTHONY TERRANOVA D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 12/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1850 N ALAFAYA TRL STE 1-B
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32826-4745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-658-8595
-----------------------------------------------------
Fax | 407-658-8573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1850 N ALAFAYA TRL STE 1-B
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32826-4745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-658-8595
-----------------------------------------------------
Fax | 407-658-8573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH8764
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------