Provider Demographics
NPI:1790959518
Name:THE LAKOTA MEDICAL
Entity Type:Organization
Organization Name:THE LAKOTA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTALAMACHIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-253-0800
Mailing Address - Street 1:3200 S HIAWASSEE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6317
Mailing Address - Country:US
Mailing Address - Phone:407-253-0800
Mailing Address - Fax:407-253-0806
Practice Address - Street 1:3200 S HIAWASSEE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6317
Practice Address - Country:US
Practice Address - Phone:407-253-0800
Practice Address - Fax:407-253-0806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DAY SPA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-14
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-9136111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8144Medicare PIN