Provider Demographics
NPI:1760937890
Name:NONA FUNCTIONAL CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:NONA FUNCTIONAL CHIROPRACTIC PLLC
Other - Org Name:RAIJOSE ROSA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAIJOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-350-1594
Mailing Address - Street 1:9161 NARCOOSSEE RD # B208
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-5764
Mailing Address - Country:US
Mailing Address - Phone:407-350-1594
Mailing Address - Fax:321-396-7667
Practice Address - Street 1:9161 NARCOOSSEE RD # B208
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5764
Practice Address - Country:US
Practice Address - Phone:407-350-1594
Practice Address - Fax:321-396-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty