Provider Demographics
NPI:1629122379
Name:TOBENAS, ED (DC)
Entity Type:Individual
Prefix:DR
First Name:ED
Middle Name:
Last Name:TOBENAS
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 1:1900 BOOTHE CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6751
Mailing Address - Country:US
Mailing Address - Phone:407-774-6800
Mailing Address - Fax:407-774-6806
Practice Address - Street 1:1900 BOOTHE CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6751
Practice Address - Country:US
Practice Address - Phone:407-774-6800
Practice Address - Fax:407-774-6806
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64003OtherBCBS OF FL
FL64003OtherBCBS OF FL
FLV07410Medicare UPIN