Organization
HEAVENLY TOUCH CHIROPRACTIC REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOTEUAISA WILSON (MANAGER)
(863) 647-0808
Entity
Organization
Contact information
Practice address
202 LAKE MIRIAM DR, SUITE W-3, LAKELAND, FL 33813-2180
(863) 647-0808
Mailing address
202 LAKE MIRIAM DR, SUITE W-3, LAKELAND, FL 33813-2180
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
111NR0400X
Rehabilitation Chiropractor
—
—
Other
Enumeration date
12/14/2015
Last updated
12/14/2015
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