Provider Demographics
NPI:1134208184
Name:ORTA, JOSE L (DC)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:ORTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4623 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9120
Mailing Address - Country:US
Mailing Address - Phone:561-966-7194
Mailing Address - Fax:561-966-7191
Practice Address - Street 1:2700 W CYPRESS CREEK RD
Practice Address - Street 2:C 100
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1744
Practice Address - Country:US
Practice Address - Phone:954-974-3111
Practice Address - Fax:954-974-6191
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH8243111N00000X
GA005926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70078YMedicare PIN
FL70078ZMedicare ID - Type UnspecifiedMEDICARE