Provider Demographics
NPI:1861046203
Name:INTEGRATIVE PHYSICAL MEDICINE OF HUNTERS CREEK, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PHYSICAL MEDICINE OF HUNTERS CREEK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEUPLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-318-6758
Mailing Address - Street 1:425 ALEXANDRIA BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5548
Mailing Address - Country:US
Mailing Address - Phone:407-977-3434
Mailing Address - Fax:
Practice Address - Street 1:3972 TOWN CTR BLVD UNIT 4118
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6103
Practice Address - Country:US
Practice Address - Phone:321-318-6758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty