Provider Demographics
NPI:1568649614
Name:FLORIDA CHIROPRACTIC HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:FLORIDA CHIROPRACTIC HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-774-6800
Mailing Address - Street 1:7806 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8232
Mailing Address - Country:US
Mailing Address - Phone:407-730-9311
Mailing Address - Fax:407-730-9310
Practice Address - Street 1:7806 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8232
Practice Address - Country:US
Practice Address - Phone:407-730-9311
Practice Address - Fax:407-730-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
64003OtherBLUE CROSS BLUE SHIELD
FL381994900Medicaid
NPIOther1629122379
NPIOther1629122379
FL64003ZMedicare PIN
V07410Medicare UPIN