Provider Demographics
NPI:1689438962
Name:ORTIZ-OLAVARRIA, XAVIER (DC)
Entity type:Individual
Prefix:
First Name:XAVIER
Middle Name:
Last Name:ORTIZ-OLAVARRIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 S HWY 27 STE 18
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6877
Mailing Address - Country:US
Mailing Address - Phone:352-329-7276
Mailing Address - Fax:
Practice Address - Street 1:2391 S HWY 27 STE 18
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6877
Practice Address - Country:US
Practice Address - Phone:352-329-7276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor