Provider Demographics
NPI:1104131358
Name:NIGHTLIGHT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:NIGHTLIGHT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:COBB
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-982-7733
Mailing Address - Street 1:826 MENENDEZ CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3631
Mailing Address - Country:US
Mailing Address - Phone:407-982-7733
Mailing Address - Fax:407-409-8360
Practice Address - Street 1:826 MENENDEZ CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3631
Practice Address - Country:US
Practice Address - Phone:407-982-7733
Practice Address - Fax:407-409-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9291111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty