Provider Demographics
NPI:1346597960
Name:MAITLAND WEST CHIROPRACTIC & LASER INC.
Entity Type:Organization
Organization Name:MAITLAND WEST CHIROPRACTIC & LASER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-972-8917
Mailing Address - Street 1:1720 FENNELL ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-8672
Mailing Address - Country:US
Mailing Address - Phone:321-972-8917
Mailing Address - Fax:321-800-3383
Practice Address - Street 1:1720 FENNELL ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8672
Practice Address - Country:US
Practice Address - Phone:321-972-8917
Practice Address - Fax:321-800-3383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9501305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBM8842Medicare PIN