Provider Demographics
NPI:1124363338
Name:CHIRO MED HEALTH & WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:CHIRO MED HEALTH & WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-601-7787
Mailing Address - Street 1:7450 DR. PHILLIPS BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5120
Mailing Address - Country:US
Mailing Address - Phone:407-601-7787
Mailing Address - Fax:407-601-7789
Practice Address - Street 1:7450 DR. PHILLIPS BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5120
Practice Address - Country:US
Practice Address - Phone:407-601-7787
Practice Address - Fax:407-601-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGR026ZMedicare PIN