Provider Demographics
NPI:1467737130
Name:HEATHROW FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:HEATHROW FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-756-6998
Mailing Address - Street 1:1601 CHERRY LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1962
Mailing Address - Country:US
Mailing Address - Phone:407-756-6998
Mailing Address - Fax:
Practice Address - Street 1:1130 TOWNPARK AVE
Practice Address - Street 2:SUITE 1116
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4787
Practice Address - Country:US
Practice Address - Phone:407-756-6998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty