Provider Demographics
NPI:1164709812
Name:EAST COLONIAL CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:EAST COLONIAL CHIROPRACTIC OFFICE
Other - Org Name:JAFFE CHIROPRACTIC & WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-658-6500
Mailing Address - Street 1:11500 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2197
Mailing Address - Country:US
Mailing Address - Phone:407-658-6500
Mailing Address - Fax:407-277-2690
Practice Address - Street 1:11500 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2197
Practice Address - Country:US
Practice Address - Phone:407-658-6500
Practice Address - Fax:407-277-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
FLCH0006110111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051009200Medicaid
FL051009200Medicaid
22446Medicare PIN