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General NPI Number Information
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NPI Number | 1891004065
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Entity Type | Organization
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Legal Business Name | FLORIDA PROFESSIONAL CHIROPRACTIC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 100 S SCENIC HWY SUITE 105
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City | LAKE WALES
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State | FL
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Zip | 33853-3827
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Country | US
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Telephone | 863-676-2225
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Fax | 863-676-0698
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Provider Business Mailing Address
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Address Line | 100 S SCENIC HWY SUITE 105
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City | LAKE WALES
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State | FL
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Zip | 33853-3827
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Country | US
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Telephone | 863-676-2225
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Fax | 863-676-0698
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. KELLIE ANNE FARO
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Credential |
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Telephone | 863-676-2225
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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 | CH6181
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License Number State | FL
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