Provider Demographics
NPI:1891349171
Name:CENTRAL FLORIDA CONCUSSION INSTITUTE LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA CONCUSSION INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTMORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-247-8267
Mailing Address - Street 1:305 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-4113
Mailing Address - Country:US
Mailing Address - Phone:863-247-8267
Mailing Address - Fax:863-247-8269
Practice Address - Street 1:305 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4113
Practice Address - Country:US
Practice Address - Phone:863-247-8267
Practice Address - Fax:863-247-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty