Provider Demographics
NPI:1407083777
Name:NORTH ORLANDO SPINE CENTER, LLC
Entity Type:Organization
Organization Name:NORTH ORLANDO SPINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:INGRANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-331-9913
Mailing Address - Street 1:2160 W STATE ROAD 434
Mailing Address - Street 2:STE 108
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5003
Mailing Address - Country:US
Mailing Address - Phone:407-331-9913
Mailing Address - Fax:407-331-9918
Practice Address - Street 1:2160 W STATE ROAD 434
Practice Address - Street 2:STE 108
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5003
Practice Address - Country:US
Practice Address - Phone:407-331-9913
Practice Address - Fax:407-331-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCV491AOtherMEDICARE PTAN