NPIMap

Organization Active NPI

Socc PL

  • Chiropractor
  • Orlando, FL
National Provider Identifier
1861450652
Registry record updated Mar 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH6499 Issued in FL
Legal business name
SOCC PL
Practice address
4170 Town Center Blvd
Suite 100
Orlando, FL 32837-5873
Phone
(407) 857-6166
Fax
(407) 857-0122
NPI assigned
May 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeffrey N. Shebovsky, DCNPI 1164583654
Title
Clinic Director Chiropractor
Phone
(407) 857-6166

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH6499 FL Primary
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X CH6499 FL

Addresses

Primary practice location

4170 Town Center Blvd
Suite 100
Orlando, FL 32837-5873

Mailing address

4170 Town Center Blvd
Suite 100
Orlando, FL 32837-5873
Phone (407) 857-6166

Other identifiers 1

IdentifierTypeStateIssuer
380451800MedicaidFL

Other names 1

  • South Orange Wellness & Injury Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090508000472 FL Part B Supplier - Clinic/Group Practice 4486702065 Receives reassigned benefits from 5 practitioners
Practice locations: Orlando, FL

National Provider Directory

National Provider Directory

Locations

4170 W Town Center Blvd
Ste 100
Orlando, FL 32837
Phone (407) 857-6166

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236297600000",
    "number": "1861450652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4170 TOWN CENTER BLVD",
            "address_2": "SUITE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328375873",
            "telephone_number": "407-857-6166",
            "fax_number": "407-857-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 TOWN CENTER BLVD",
            "address_2": "SUITE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328375873",
            "telephone_number": "407-857-6166",
            "fax_number": "407-857-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCC PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2009-03-06",
        "status": "A",
        "authorized_official_last_name": "SHEBOVSKY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CLINIC DIRECTOR CHIROPRACTOR",
        "authorized_official_telephone_number": "407-857-6166",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH6499",
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "FL",
            "license": "CH6499",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "380451800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Orange Wellness & Injury Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.