Provider Demographics
NPI:1306830724
Name:PRECISION CHIROPRACTIC ORLANDO INC.
Entity Type:Organization
Organization Name:PRECISION CHIROPRACTIC ORLANDO INC.
Other - Org Name:AVARTA WELLNESS INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:STAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-228-9599
Mailing Address - Street 1:3837 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5207
Mailing Address - Country:US
Mailing Address - Phone:407-228-9599
Mailing Address - Fax:866-257-2827
Practice Address - Street 1:3837 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5207
Practice Address - Country:US
Practice Address - Phone:407-228-9599
Practice Address - Fax:866-257-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70221OtherBLUE CROSS / BLUE SHIELD
FL70221OtherBLUE CROSS / BLUE SHIELD