Provider Demographics
NPI:1124886361
Name:ATWI, AMJAD (DC)
Entity type:Individual
Prefix:
First Name:AMJAD
Middle Name:
Last Name:ATWI
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 1:1093 HORIZON VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-5290
Mailing Address - Country:US
Mailing Address - Phone:508-333-1610
Mailing Address - Fax:
Practice Address - Street 1:9685 LAKE NONA VILLAGE PL STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7322
Practice Address - Country:US
Practice Address - Phone:407-627-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor