Provider Demographics
NPI:1376624825
Name:ROA-OLMO, ALEX C (DC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:C
Last Name:ROA-OLMO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:C
Other - Last Name:ROA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1151 BLACKWOOD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4519
Mailing Address - Country:US
Mailing Address - Phone:407-205-8847
Mailing Address - Fax:407-930-3544
Practice Address - Street 1:1151 BLACKWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4519
Practice Address - Country:US
Practice Address - Phone:407-205-8847
Practice Address - Fax:407-930-3544
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor