Provider Demographics
NPI:1700496841
Name:AVE K CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:AVE K CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-802-7731
Mailing Address - Street 1:1417 LITCHEM RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3068
Mailing Address - Country:US
Mailing Address - Phone:407-802-7731
Mailing Address - Fax:
Practice Address - Street 1:308 AVENUE K SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4147
Practice Address - Country:US
Practice Address - Phone:863-229-5353
Practice Address - Fax:863-875-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty