Provider Demographics
NPI:1528390705
Name:ORTIZ, LANDON MIGUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:LANDON
Middle Name:MIGUEL
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 EDWIN PL
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1441
Mailing Address - Country:US
Mailing Address - Phone:828-252-1882
Mailing Address - Fax:828-252-1417
Practice Address - Street 1:75 EDWIN PL
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1441
Practice Address - Country:US
Practice Address - Phone:828-252-1882
Practice Address - Fax:828-252-1417
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913665Medicaid
NC5913665Medicaid