Provider Demographics
NPI:1982884698
Name:MAURICIO CHIROPRACTIC CLINICS PA
Entity Type:Organization
Organization Name:MAURICIO CHIROPRACTIC CLINICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-381-0878
Mailing Address - Street 1:12278 E COLONIAL DRIVE
Mailing Address - Street 2:STE. 600F
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826
Mailing Address - Country:US
Mailing Address - Phone:407-381-0878
Mailing Address - Fax:407-373-6046
Practice Address - Street 1:1810 SEMORAN BLVD
Practice Address - Street 2:STE 104
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-672-1616
Practice Address - Fax:407-672-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
55274YMedicare PIN