Provider Demographics
NPI:1538581319
Name:KISSIMMEE CHIROPRACTIC CENTER AND REHAB INC
Entity type:Organization
Organization Name:KISSIMMEE CHIROPRACTIC CENTER AND REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-580-0950
Mailing Address - Street 1:10540 BASTILLE LN
Mailing Address - Street 2:# 310
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-4618
Mailing Address - Country:US
Mailing Address - Phone:407-580-0950
Mailing Address - Fax:
Practice Address - Street 1:215 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3311
Practice Address - Country:US
Practice Address - Phone:407-580-0950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty