Provider Demographics
NPI:1164294286
Name:IDEAL CHIROPRACTIC & BODY CONTOUR LLC
Entity Type:Organization
Organization Name:IDEAL CHIROPRACTIC & BODY CONTOUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUTRUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-431-8539
Mailing Address - Street 1:3975 S ORANGE BLOSSOM TRL STE 105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-7905
Mailing Address - Country:US
Mailing Address - Phone:407-203-0203
Mailing Address - Fax:
Practice Address - Street 1:3975 S ORANGE BLOSSOM TRL STE 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-7905
Practice Address - Country:US
Practice Address - Phone:407-203-0203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty