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General NPI Number Information
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NPI Number | 1871716597
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Entity Type | Organization
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Legal Business Name | ISNER CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1515 HERBERT ST STE 209
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City | PORT ORANGE
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State | FL
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Zip | 32129-6105
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Country | US
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Telephone | 386-767-7510
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Fax | 386-767-7511
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Provider Business Mailing Address
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Address Line | 1103 NATURE VIEW CIR
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City | PORT ORANGE
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State | FL
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Zip | 32128-7454
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Country | US
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Telephone | 386-788-2596
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW OWEN ISNER
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Credential | DC
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Telephone | 386-852-0110
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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 | CHIRO08035
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License Number State | GA
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