Provider Demographics
NPI:1861450652
Name:SOCC PL
Entity Type:Organization
Organization Name:SOCC PL
Other - Org Name:SOUTH ORANGE WELLNESS & INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHEBOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-857-6166
Mailing Address - Street 1:4170 TOWN CENTER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5873
Mailing Address - Country:US
Mailing Address - Phone:407-857-6166
Mailing Address - Fax:407-857-0122
Practice Address - Street 1:4170 TOWN CENTER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-5873
Practice Address - Country:US
Practice Address - Phone:407-857-6166
Practice Address - Fax:407-857-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6499111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380451800Medicaid
FL22970Medicare ID - Type Unspecified
FLU48306Medicare UPIN