Provider Demographics
NPI:1245459320
Name:NUESTRO CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:NUESTRO CHIROPRACTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST-CHIROPRACTIC ASST
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMILO
Authorized Official - Middle Name:NO
Authorized Official - Last Name:ARBOLEDA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CCPA
Authorized Official - Phone:407-240-8884
Mailing Address - Street 1:8204 CRYSTAL CLEAR LN STE 1500
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7757
Mailing Address - Country:US
Mailing Address - Phone:407-240-8884
Mailing Address - Fax:401-240-8388
Practice Address - Street 1:8204 CRYSTAL CLEAR LN STE 1500
Practice Address - Street 2:8204 CRYSTAL CLEAR LN, STE 1500
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7757
Practice Address - Country:US
Practice Address - Phone:407-240-8884
Practice Address - Fax:401-240-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service