Provider Demographics
NPI:1215138433
Name:MACENA, YVES (OWNER)
Entity type:Individual
Prefix:MR
First Name:YVES
Middle Name:
Last Name:MACENA
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:MR
Other - First Name:YVES
Other - Middle Name:
Other - Last Name:MACENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OWNER
Mailing Address - Street 1:115 E LANCASTER RD
Mailing Address - Street 2:STE. B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-6689
Mailing Address - Country:US
Mailing Address - Phone:407-362-7075
Mailing Address - Fax:407-240-5443
Practice Address - Street 1:115 E LANCASTER RD
Practice Address - Street 2:STE. B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-6689
Practice Address - Country:US
Practice Address - Phone:407-362-7075
Practice Address - Fax:407-240-5443
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty