Provider Demographics
NPI:1821336330
Name:DR. KOTEUAISA CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:DR. KOTEUAISA CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOTEUAISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-745-7859
Mailing Address - Street 1:805 S KIRKMAN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2200
Mailing Address - Country:US
Mailing Address - Phone:407-745-1859
Mailing Address - Fax:407-264-6662
Practice Address - Street 1:805 S KIRKMAN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2200
Practice Address - Country:US
Practice Address - Phone:407-745-1859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty