Provider Demographics
NPI:1154489326
Name:INDERWIESEN, DAVID ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:INDERWIESEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11905 E COLONIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4725
Mailing Address - Country:US
Mailing Address - Phone:407-281-0900
Mailing Address - Fax:407-281-0900
Practice Address - Street 1:12484 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7100
Practice Address - Country:US
Practice Address - Phone:407-281-0900
Practice Address - Fax:407-281-0900
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381458100Medicaid
FL22661OtherBCBS OF FL
22661Medicare UPIN
FL381458100Medicaid