Provider Demographics
NPI:1801012901
Name:WEST ORANGE CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:WEST ORANGE CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-253-4041
Mailing Address - Street 1:1151 BLACKWOOD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4519
Mailing Address - Country:US
Mailing Address - Phone:407-253-4041
Mailing Address - Fax:407-253-1470
Practice Address - Street 1:1151 BLACKWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4519
Practice Address - Country:US
Practice Address - Phone:407-253-4041
Practice Address - Fax:407-253-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6992305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL657720OtherACN
FL55700OtherBCBS