Provider Demographics
NPI:1861815961
Name:BELLOMO CHIROPRACTIC LIFE CENTER P.A.
Entity Type:Organization
Organization Name:BELLOMO CHIROPRACTIC LIFE CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BELLOMO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:497-295-1077
Mailing Address - Street 1:6442 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4204
Mailing Address - Country:US
Mailing Address - Phone:407-295-1077
Mailing Address - Fax:407-296-2196
Practice Address - Street 1:6442 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4204
Practice Address - Country:US
Practice Address - Phone:407-295-1077
Practice Address - Fax:407-296-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty