Provider Demographics
NPI:1114035961
Name:LOPEZ, NASLY MENENDEZ (DC)
Entity Type:Individual
Prefix:DR
First Name:NASLY
Middle Name:MENENDEZ
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15497 STONEYBROOK WEST PKWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4770
Mailing Address - Country:US
Mailing Address - Phone:407-654-9888
Mailing Address - Fax:407-654-9886
Practice Address - Street 1:15497 STONEYBROOK WEST PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4770
Practice Address - Country:US
Practice Address - Phone:407-654-9888
Practice Address - Fax:407-654-9886
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6796111N00000X
FLCH9289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGVCMedicare ID - Type Unspecified
GAU90183Medicare UPIN