Organization
FAITH CHIROPRACTICE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT JON MICCICHE (PRESIDENT)
(407) 290-8662
Entity
Organization
Contact information
Practice address
2459 S HIAWASSEE, ORLANDO, FL 32835
(407) 290-8662
(407) 290-6142
Mailing address
2459 S HIAWASSEE, ORLANDO, FL 32835
(407) 290-8662
(407) 290-6142
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH5356
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z036
BC BS
FL
Enumeration date
12/11/2006
Last updated
08/22/2020
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