Provider Demographics
NPI:1477885143
Name:JODI JAKIEL, LLC
Entity Type:Organization
Organization Name:JODI JAKIEL, LLC
Other - Org Name:ACTIVE LIVING HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JAKIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-384-4904
Mailing Address - Street 1:8257 NARCOOSSEE PARK DR
Mailing Address - Street 2:SUITE 516
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5545
Mailing Address - Country:US
Mailing Address - Phone:407-384-4904
Mailing Address - Fax:888-744-7203
Practice Address - Street 1:8257 NARCOOSSEE PARK DR
Practice Address - Street 2:SUITE 516
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5545
Practice Address - Country:US
Practice Address - Phone:407-384-4904
Practice Address - Fax:888-744-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2201FOtherBLUE CROSS