Provider Demographics
NPI:1598134181
Name:MIKHAIL FAMILY CHIROPRACTIC & SPORTS REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:MIKHAIL FAMILY CHIROPRACTIC & SPORTS REHABILITATION CENTER, LLC
Other - Org Name:MIKHAIL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DIRECTOR, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-622-6295
Mailing Address - Street 1:2601 WELLS AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2000
Mailing Address - Country:US
Mailing Address - Phone:407-622-6295
Mailing Address - Fax:407-622-2295
Practice Address - Street 1:2601 WELLS AVE STE 121
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2000
Practice Address - Country:US
Practice Address - Phone:407-622-6295
Practice Address - Fax:407-622-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty