Provider Demographics
NPI:1982948329
Name:M.H.B. LEGACY L.L.C.
Entity Type:Organization
Organization Name:M.H.B. LEGACY L.L.C.
Other - Org Name:SOUTH LAKE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARHONHDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-756-4859
Mailing Address - Street 1:255 W HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3027
Mailing Address - Country:US
Mailing Address - Phone:352-394-4615
Mailing Address - Fax:352-394-7400
Practice Address - Street 1:255 W HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3027
Practice Address - Country:US
Practice Address - Phone:352-394-4615
Practice Address - Fax:352-394-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty