Provider Demographics
NPI:1851901201
Name:ORANGE BLOSSOM INJURY, HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ORANGE BLOSSOM INJURY, HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-802-7731
Mailing Address - Street 1:1221 W COLONIAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7156
Mailing Address - Country:US
Mailing Address - Phone:407-704-1200
Mailing Address - Fax:407-704-8005
Practice Address - Street 1:1221 W COLONIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7156
Practice Address - Country:US
Practice Address - Phone:407-704-1200
Practice Address - Fax:407-704-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty