Provider Demographics
NPI:1568647444
Name:ORLANDO EMERGENCY CHIROPRACTIC
Entity Type:Organization
Organization Name:ORLANDO EMERGENCY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LARIVEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-966-1775
Mailing Address - Street 1:9753 SOUTH ORANGE BLOSSOM TRAIL
Mailing Address - Street 2:GEORGE PROFESSIONAL BUILDING
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837
Mailing Address - Country:US
Mailing Address - Phone:561-966-1775
Mailing Address - Fax:
Practice Address - Street 1:9753 SOUTH ORANGE BLOSSOM TRAIL
Practice Address - Street 2:GEORGE PROFESSIONAL BUILDING
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:561-966-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL69002OtherBC BS