Provider Demographics
NPI:1346860236
Name:SOUTH ORLANDO CHIROPRACTIC & INJURY CENTER
Entity Type:Organization
Organization Name:SOUTH ORLANDO CHIROPRACTIC & INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PCEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-704-6705
Mailing Address - Street 1:5833 S GOLDENROD RD STE F
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8777
Mailing Address - Country:US
Mailing Address - Phone:407-704-6705
Mailing Address - Fax:407-704-6254
Practice Address - Street 1:5833 S GOLDENROD RD STE F
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8777
Practice Address - Country:US
Practice Address - Phone:407-704-6705
Practice Address - Fax:407-704-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty