Provider Demographics
NPI:1568273852
Name:SANTANA, MAX JERENY (DC)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:JERENY
Last Name:SANTANA
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 1:1314 TOMOKA TOWN CENTER DR APT 304
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5220
Mailing Address - Country:US
Mailing Address - Phone:787-231-1603
Mailing Address - Fax:
Practice Address - Street 1:520 W LAKE MARY BLVD STE 214
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7424
Practice Address - Country:US
Practice Address - Phone:407-507-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor