Provider Demographics
NPI:1346492345
Name:NETWORK CHIROPRACTIC UBO
Entity Type:Organization
Organization Name:NETWORK CHIROPRACTIC UBO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-831-1236
Mailing Address - Street 1:356 GOLFSIDE CV
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4669
Mailing Address - Country:US
Mailing Address - Phone:407-774-7951
Mailing Address - Fax:407-774-7951
Practice Address - Street 1:741 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6835
Practice Address - Country:US
Practice Address - Phone:407-831-1236
Practice Address - Fax:407-831-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1669472668OtherINDIVIDUAL PRACTIONER
FL1669472668OtherINDIVIDUAL PRACTIONER