Provider Demographics
NPI:1326446758
Name:IMMANUEL'S IMAGES, INC
Entity Type:Organization
Organization Name:IMMANUEL'S IMAGES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RDMS, RDCS, CCT
Authorized Official - Phone:407-832-5066
Mailing Address - Street 1:1746 E SILVER STAR RD
Mailing Address - Street 2:STE 121
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:954 LAKE BALDWIN LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6651
Practice Address - Country:US
Practice Address - Phone:407-832-5066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NT0100XChiropractic ProvidersChiropractorThermographyGroup - Single Specialty