Provider Demographics
NPI:1497742910
Name:OVIEDO INJURY & WELLNESS CENTER
Entity Type:Organization
Organization Name:OVIEDO INJURY & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:RESSLER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:407-977-5005
Mailing Address - Street 1:870 CLARK ST. STE 1040
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9270
Mailing Address - Country:US
Mailing Address - Phone:407-977-5005
Mailing Address - Fax:407-366-3327
Practice Address - Street 1:870 CLARK ST STE 1040
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9270
Practice Address - Country:US
Practice Address - Phone:407-977-5005
Practice Address - Fax:407-366-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381399100Medicaid
FL381399100Medicaid
FLU87752-0001Medicare UPIN