Provider Demographics
NPI:1285119073
Name:ORLANDO INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:ORLANDO INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RAOUF
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-217-3986
Mailing Address - Street 1:1954 W SR 426 STE 1112
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8831
Mailing Address - Country:US
Mailing Address - Phone:407-890-9651
Mailing Address - Fax:407-890-9660
Practice Address - Street 1:1954 W SR 426 STE 1112
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8831
Practice Address - Country:US
Practice Address - Phone:407-890-9651
Practice Address - Fax:407-890-9660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORLANDO INTEGRATIVE MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty