Provider Demographics
NPI:1497935118
Name:MAURICIO CHIROPRACTIC NORTH LLC
Entity Type:Organization
Organization Name:MAURICIO CHIROPRACTIC NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-260-8879
Mailing Address - Street 1:PO BOX 520438
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32752-0438
Mailing Address - Country:US
Mailing Address - Phone:407-260-8879
Mailing Address - Fax:321-594-5809
Practice Address - Street 1:821 DEBARY AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8805
Practice Address - Country:US
Practice Address - Phone:386-860-5448
Practice Address - Fax:386-368-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60001ZMedicare PIN