Provider Demographics
NPI:1942320213
Name:ANDERS CHIROPRACTIC & SPORTS PERFORMANCE LLC
Entity Type:Organization
Organization Name:ANDERS CHIROPRACTIC & SPORTS PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-249-3300
Mailing Address - Street 1:11873 HIGH TECH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-8364
Mailing Address - Country:US
Mailing Address - Phone:407-249-3300
Mailing Address - Fax:407-249-3322
Practice Address - Street 1:11873 HIGH TECH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8364
Practice Address - Country:US
Practice Address - Phone:407-249-3300
Practice Address - Fax:407-249-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty