10D2075173 CLIA NUMBER - DG & LEEDS LLC DBA ORLANDO PAIN CLINIC

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Laboratory Demographics

CLIA Number: 10D2075173

Facility Name: DG & LEEDS LLC DBA ORLANDO PAIN CLINIC

Facility Address:
280 S STATE ROAD 434 SUITE 1049
ALTAMONTE SPRINGS, FL
ZIP 32714
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Facility Phone Number: 321 280-5052

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1053670018

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	10D2075173
LAB Type	Practitioner Other
Facility Name	DG & LEEDS LLC DBA ORLANDO PAIN CLINIC
Street	280 S STATE ROAD 434 SUITE 1049
City	ALTAMONTE SPRINGS
State	FL
ZIP	32714
Phone	321 280-5052
CertificateType	4
CertificateEffectiveDate	3/24/2024
CertificateExpirationDate	3/23/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024