Provider Demographics
NPI:1841347689
Name:INTERNATIONAL CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:INTERNATIONAL CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-291-2889
Mailing Address - Street 1:5030 DR PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3310
Mailing Address - Country:US
Mailing Address - Phone:407-291-2889
Mailing Address - Fax:407-291-2994
Practice Address - Street 1:5030 DR PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3310
Practice Address - Country:US
Practice Address - Phone:407-291-2889
Practice Address - Fax:407-291-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22351Medicare ID - Type Unspecified
FL12629Medicare UPIN