Provider Demographics
NPI:1407039639
Name:22 HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:22 HEALTH GROUP, LLC
Other - Org Name:22 HEALTH ALTAMONTE, SERIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:USINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-951-8921
Mailing Address - Street 1:1052 W STATE ROAD 436
Mailing Address - Street 2:SUITE 1070
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2939
Mailing Address - Country:US
Mailing Address - Phone:407-951-8921
Mailing Address - Fax:407-951-8926
Practice Address - Street 1:1052 W STATE ROAD 436
Practice Address - Street 2:SUITE 1070
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2939
Practice Address - Country:US
Practice Address - Phone:407-951-8921
Practice Address - Fax:407-951-8926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7224111N00000X, 111N00000X
111NR0200X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381287100Medicaid
FLK6263Medicare PIN
FL55612OtherBLUE CROSS BLUE SHIELD