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General NPI Number Information
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NPI Number | 1790959518
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Entity Type | Organization
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Legal Business Name | THE LAKOTA MEDICAL
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 3200 S HIAWASSEE RD SUITE 203
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City | ORLANDO
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State | FL
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Zip | 32835-6317
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Country | US
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Telephone | 407-253-0800
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Fax | 407-253-0806
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Provider Business Mailing Address
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Address Line | 3200 S HIAWASSEE RD SUITE 203
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City | ORLANDO
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State | FL
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Zip | 32835-6317
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Country | US
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Telephone | 407-253-0800
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Fax | 407-253-0806
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. ELYSE SALTALAMACHIA
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Credential | DC
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Telephone | 407-253-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | CH-9136
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License Number State | FL
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