Provider Demographics
NPI:1023559432
Name:PREFERRED INJURY PHYSICIANS OF KISSIMMEE
Entity Type:Organization
Organization Name:PREFERRED INJURY PHYSICIANS OF KISSIMMEE
Other - Org Name:PREFERRED INJURY PHYSICIANS OF KISSIMMEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:UTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-509-1414
Mailing Address - Street 1:109 TERRA MANGO LOOP STE B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8511
Mailing Address - Country:US
Mailing Address - Phone:407-900-7246
Mailing Address - Fax:
Practice Address - Street 1:207 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3311
Practice Address - Country:US
Practice Address - Phone:407-900-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty