Provider Demographics
NPI:1225433741
Name:LAKE NONA SPINE CENTER, INC.
Entity Type:Organization
Organization Name:LAKE NONA SPINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PCEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-299-5266
Mailing Address - Street 1:10979 SAVANNAH LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5104
Mailing Address - Country:US
Mailing Address - Phone:321-299-5266
Mailing Address - Fax:407-403-6550
Practice Address - Street 1:10979 SAVANNAH LANDING CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5104
Practice Address - Country:US
Practice Address - Phone:321-299-5266
Practice Address - Fax:407-403-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty