Provider Demographics
NPI:1578372496
Name:MUNOZ BURGOS, ETIENNE ANDRES (DC)
Entity type:Individual
Prefix:DR
First Name:ETIENNE
Middle Name:ANDRES
Last Name:MUNOZ BURGOS
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 1:80 LAKEVIEW DR APT 419
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5840
Mailing Address - Country:US
Mailing Address - Phone:787-666-9968
Mailing Address - Fax:
Practice Address - Street 1:508 S HABANA AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4137
Practice Address - Country:US
Practice Address - Phone:813-308-0637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor