Provider Demographics
NPI:1881055440
Name:ORTIZ, JOSE (DC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 S WILLIAMSON BLVD APT 132
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6096
Mailing Address - Country:US
Mailing Address - Phone:386-265-7807
Mailing Address - Fax:
Practice Address - Street 1:6315 S WILLIAMSON BLVD APT 132
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128
Practice Address - Country:US
Practice Address - Phone:386-265-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor