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General NPI Number Information
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NPI Number | 1932564572
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Entity Type | Organization
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Legal Business Name | ENCOMPASS CHIROPRACTIC EAST LLC
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 6485 S CHICKASAW TRL UNIT #A103
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City | ORLANDO
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State | FL
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Zip | 32829-8366
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Country | US
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Telephone | 407-704-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 6485 S CHICKASAW TRL UNIT #A103
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City | ORLANDO
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State | FL
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Zip | 32829-8366
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Country | US
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Telephone | 407-704-3535
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | VICTOR LASA
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Credential | DC
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Telephone | 407-740-3535
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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 | CH9316
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License Number State | FL
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