Provider Demographics
NPI:1255459301
Name:SANTANA, JORGE LUIS (DC)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:SANTANA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 LETAP CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7218
Mailing Address - Country:US
Mailing Address - Phone:813-448-2222
Mailing Address - Fax:813-948-7111
Practice Address - Street 1:2718 LETAP CT
Practice Address - Street 2:SUITE 101
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7218
Practice Address - Country:US
Practice Address - Phone:813-448-2222
Practice Address - Fax:813-948-7111
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007900200Medicaid
FL70013OtherBCBSFL
FLEZ192YMedicare PIN
FL70013OtherBCBSFL