1497935118 NPI number — MAURICIO CHIROPRACTIC NORTH LLC

Table of content: (NPI 1497935118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497935118 NPI number — MAURICIO CHIROPRACTIC NORTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAURICIO CHIROPRACTIC NORTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497935118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 520438
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32752-0438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-260-8879
Provider Business Mailing Address Fax Number:
321-594-5809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 DEBARY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELTONA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32725-8805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-860-5448
Provider Business Practice Location Address Fax Number:
386-368-3665
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARIAS
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
AREA MANAGER
Authorized Official Telephone Number:
407-260-8879

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH7903 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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