Provider Demographics
NPI:1922380658
Name:FLORIDIAN CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:FLORIDIAN CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGASSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-977-7755
Mailing Address - Street 1:561 E MITCHELL HAMMOCK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5526
Mailing Address - Country:US
Mailing Address - Phone:407-977-7755
Mailing Address - Fax:407-977-7788
Practice Address - Street 1:561 E MITCHELL HAMMOCK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5526
Practice Address - Country:US
Practice Address - Phone:407-977-7755
Practice Address - Fax:407-977-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFK336AMedicare PIN