Provider Demographics
NPI:1689870412
Name:MAURICIO CHIROPRACTIC SOUTH L L C
Entity Type:Organization
Organization Name:MAURICIO CHIROPRACTIC SOUTH L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-381-0878
Mailing Address - Street 1:12278 E. COLONIAL DR.
Mailing Address - Street 2:STE 600C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826
Mailing Address - Country:US
Mailing Address - Phone:407-381-0878
Mailing Address - Fax:407-373-6046
Practice Address - Street 1:12720 S ORANGE BLOSSOM TRAIL
Practice Address - Street 2:#20
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:407-438-4888
Practice Address - Fax:321-319-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty