Provider Demographics
NPI:1780151662
Name:PREFERRED INJURY PHYSICIANS OF EAST ORLANDO INC
Entity type:Organization
Organization Name:PREFERRED INJURY PHYSICIANS OF EAST ORLANDO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR. /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD JACK
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:UTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-900-7246
Mailing Address - Street 1:1417 N SEMORAN BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3555
Mailing Address - Country:US
Mailing Address - Phone:407-900-7246
Mailing Address - Fax:
Practice Address - Street 1:1417 N SEMORAN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3555
Practice Address - Country:US
Practice Address - Phone:407-900-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid
FL=========OtherCHIROPRACTIC