Provider Demographics
NPI:1902151814
Name:WELLNESS WAY TAMPA LLC
Entity Type:Organization
Organization Name:WELLNESS WAY TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ATC
Authorized Official - Phone:813-996-4773
Mailing Address - Street 1:27552 CASHFORD CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6951
Mailing Address - Country:US
Mailing Address - Phone:813-996-4773
Mailing Address - Fax:813-762-1413
Practice Address - Street 1:27552 CASHFORD CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6951
Practice Address - Country:US
Practice Address - Phone:813-973-8883
Practice Address - Fax:813-762-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9195261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center