MEDICARE: SOUTH ORLANDO CHIROPRACTIC & INJURY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1346860236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ORLANDO CHIROPRACTIC & INJURY CENTER

Provider Business Mailing Address
First Line	:	5833 S GOLDENROD RD STE F
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8777
Country	:	US
Telephone Number	:	407-704-6705
Fax Number	:	407-704-6254

Provider Business Practice Location Address
First Line	:	5833 S GOLDENROD RD STE F
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8777
Country	:	US
Telephone Number	:	407-704-6705
Fax Number	:	407-704-6254

Authorized Official
Title or Position	:	PCEO
Name	:	DR. CHRISTOPHER MATTHEW VANN
Credential	:	DC
Telephone Number	:	407-704-6705

Provider Enumeration Date	:	04/21/2020
Last Update Date	:	04/21/2020

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