Provider Demographics
NPI:1205436565
Name:ROOT OF WELLNESS LLC
Entity type:Organization
Organization Name:ROOT OF WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-762-2598
Mailing Address - Street 1:1301 BEVILLE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1503
Mailing Address - Country:US
Mailing Address - Phone:386-322-9800
Mailing Address - Fax:
Practice Address - Street 1:1301 BEVILLE RD STE 6
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1503
Practice Address - Country:US
Practice Address - Phone:386-322-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty