Provider Demographics
NPI:1235448325
Name:FAMILY CHIROPRACTIC OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC OF CENTRAL FLORIDA
Other - Org Name:THIRTY NINE HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-767-5700
Mailing Address - Street 1:830 E STATE ROAD 434
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5362
Mailing Address - Country:US
Mailing Address - Phone:407-767-5700
Mailing Address - Fax:
Practice Address - Street 1:830 E STATE ROAD 434
Practice Address - Street 2:SUITE 1
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5362
Practice Address - Country:US
Practice Address - Phone:407-767-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8237111N00000X
FLCH9818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70230OtherMEDICARE