Provider Demographics
NPI:1750495602
Name:WINTER PARK COMPLEMENTARY MEDICINE
Entity type:Organization
Organization Name:WINTER PARK COMPLEMENTARY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAFFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-644-8197
Mailing Address - Street 1:670 NORTH ORLANDO AVENUE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-644-8197
Mailing Address - Fax:407-644-8198
Practice Address - Street 1:670 NORTH ORLANDO AVENUE
Practice Address - Street 2:SUITE #103
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:407-644-8197
Practice Address - Fax:407-644-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-7669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK-4352Medicare UPIN