Provider Demographics
NPI:1942749197
Name:ORLANDO INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:ORLANDO INTEGRATIVE MEDICINE
Other - Org Name:CRYONEXT INTEGRATIVE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RAOUF
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-217-3986
Mailing Address - Street 1:1954 W STATE ROAD 426
Mailing Address - Street 2:# 1112
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8891
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1954 W STATE ROAD 426
Practice Address - Street 2:# 1112
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8891
Practice Address - Country:US
Practice Address - Phone:321-217-3986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty