Provider Demographics
NPI:1982953923
Name:BELLER CHIROPRACTIC FLORIDA, LLC
Entity type:Organization
Organization Name:BELLER CHIROPRACTIC FLORIDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:BELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-949-2173
Mailing Address - Street 1:13355 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3970
Mailing Address - Country:US
Mailing Address - Phone:407-614-2075
Mailing Address - Fax:
Practice Address - Street 1:13355 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3970
Practice Address - Country:US
Practice Address - Phone:407-614-2075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI143151958Medicaid