Provider Demographics
NPI:1376000851
Name:ORLANDO ALTERNATIVE HEALTH, LLC
Entity Type:Organization
Organization Name:ORLANDO ALTERNATIVE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUKOR
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:703-898-7280
Mailing Address - Street 1:32 N HYER AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2928
Mailing Address - Country:US
Mailing Address - Phone:703-898-7280
Mailing Address - Fax:
Practice Address - Street 1:1617 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4809
Practice Address - Country:US
Practice Address - Phone:703-898-7280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1922414077Other171100000X