Provider Demographics
NPI:1184089435
Name:WELLNESS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:WELLNESS CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYN
Authorized Official - Middle Name:I
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-638-4000
Mailing Address - Street 1:1018 SUNSET TRL
Mailing Address - Street 2:
Mailing Address - City:BABSON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33827-9633
Mailing Address - Country:US
Mailing Address - Phone:863-638-4000
Mailing Address - Fax:888-339-6697
Practice Address - Street 1:1018 SUNSET TRL
Practice Address - Street 2:
Practice Address - City:BABSON PARK
Practice Address - State:FL
Practice Address - Zip Code:33827-9633
Practice Address - Country:US
Practice Address - Phone:863-638-4000
Practice Address - Fax:888-339-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55370Medicare UPIN