Provider Demographics
NPI:1376729525
Name:LAKE MARY CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:LAKE MARY CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-302-5161
Mailing Address - Street 1:3240 W LAKE MARY BLVD
Mailing Address - Street 2:STE. 1300
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3583
Mailing Address - Country:US
Mailing Address - Phone:407-302-5161
Mailing Address - Fax:
Practice Address - Street 1:3240 W LAKE MARY BLVD
Practice Address - Street 2:STE. 1300
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3583
Practice Address - Country:US
Practice Address - Phone:407-302-5161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty