Provider Demographics
NPI:1891247763
Name:STEWART FAMILY & SPORTS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:STEWART FAMILY & SPORTS CHIROPRACTIC CLINIC
Other - Org Name:STEWART WELLNESS & CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-960-1542
Mailing Address - Street 1:735 LONDON RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4843
Mailing Address - Country:US
Mailing Address - Phone:407-960-1542
Mailing Address - Fax:407-960-1538
Practice Address - Street 1:1455 SEMORAN BLVD
Practice Address - Street 2:SUITE 177
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6522
Practice Address - Country:US
Practice Address - Phone:407-960-1542
Practice Address - Fax:407-960-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty