Provider Demographics
NPI:1184924615
Name:LAKE BUENA VISTA CHIROPRACTIC PA
Entity type:Organization
Organization Name:LAKE BUENA VISTA CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MCC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-238-2306
Mailing Address - Street 1:11953 S APOPKA VINELAND RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-7025
Mailing Address - Country:US
Mailing Address - Phone:407-238-2306
Mailing Address - Fax:407-238-2309
Practice Address - Street 1:11953 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-7025
Practice Address - Country:US
Practice Address - Phone:407-238-2306
Practice Address - Fax:407-238-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty