MEDICARE: EDZEL ROMAN ORTIZ DC

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	CH14707	FL

General Provider Information

NPI Number	:	1396591160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDZEL ROMAN ORTIZ DC

Provider Business Mailing Address
First Line	:	2222 S KIRKMAN RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-2308
Country	:	US
Telephone Number	:	407-802-4476
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 S KIRKMAN RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-2308
Country	:	US
Telephone Number	:	407-802-4476
Fax Number	:	407-942-3316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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Directions to “ EDZEL ROMAN ORTIZ DC” Practice Location

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