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NPI Code Detail

MEDICARE: ENCOMPASS CHIROPRACTIC MEDICAL & INJURY CENTER,LLC

MEDICARE: ENCOMPASS CHIROPRACTIC MEDICAL & INJURY CENTER,LLC
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
1111N00000XChiropractorCH9316FL

General Provider Information

NPI Number : 1821380890
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENCOMPASS CHIROPRACTIC MEDICAL & INJURY CENTER,LLC
Provider Business Mailing Address
First Line : 5336 S JOHN YOUNG PKWY
Second Line :
City : ORLANDO
State : FL
Zip : 32839-7363
Country : US
Telephone Number : 407-802-3855
Fax Number : 407-979-4967
Provider Business Practice Location Address
First Line : 5336 S JOHN YOUNG PKWY
Second Line :
City : ORLANDO
State : FL
Zip : 32839-7363
Country : US
Telephone Number : 407-802-3855
Fax Number : 407-979-4967
Authorized Official
Title or Position : OWER
Name : MR. VICTOR MANUEL LASA
Credential : DC
Telephone Number : 407-802-3855
Provider Enumeration Date : 05/10/2011
Last Update Date : 05/10/2011

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Directions to “ENCOMPASS CHIROPRACTIC MEDICAL & INJURY CENTER,LLC ” Practice Location

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