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Organization
WISE CHIROPRACTIC PA
Active
Organization
WISE CHIROPRACTIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN CRAIG WISE D.C. (PRESIDENT)
(352) 259-2225
Entity
Organization
Contact information
Practice address
17941 US HIGHWAY 441, MOUNT DORA, FL 32757-6717
(352) 516-6820
Mailing address
17941 US HIGHWAY 441, MOUNT DORA, FL 32757-6717
(352) 516-6820
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
9678
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431001936418001
CCN
FL
Enumeration date
03/04/2010
Last updated
12/19/2011
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