Provider Demographics
NPI:1467868489
Name:GREGORY COFANO, D.C., LLC
Entity Type:Organization
Organization Name:GREGORY COFANO, D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:COFANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-977-2240
Mailing Address - Street 1:8000 RED BUG LAKE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9226
Mailing Address - Country:US
Mailing Address - Phone:407-977-2240
Mailing Address - Fax:407-977-2446
Practice Address - Street 1:8000 RED BUG LAKE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9226
Practice Address - Country:US
Practice Address - Phone:407-977-2240
Practice Address - Fax:407-977-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty