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General NPI Number Information
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NPI Number | 1891903399
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Entity Type | Organization
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Legal Business Name | HAVENDALE FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1606 HAVENDALE BLVD
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City | WINTER HAVEN
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State | FL
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Zip | 33884
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Country | US
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Telephone | 863-291-0800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2038
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City | HAINES CITY
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State | FL
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Zip | 33845-2038
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Country | US
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Telephone | 863-291-0800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAMOTHE JOSPEH
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Credential |
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Telephone | 863-291-0800
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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 | HCC7248
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License Number State | FL
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