Provider Demographics
NPI:1548438385
Name:PONTE VEDRA WELLNESS CENTER INC
Entity type:Organization
Organization Name:PONTE VEDRA WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-273-2691
Mailing Address - Street 1:100 CORRIDOR RD S
Mailing Address - Street 2:STE 220
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082
Mailing Address - Country:US
Mailing Address - Phone:904-273-2691
Mailing Address - Fax:
Practice Address - Street 1:100 CORRIDOR RD S
Practice Address - Street 2:STE 220
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082
Practice Address - Country:US
Practice Address - Phone:904-273-2691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8499111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88720OtherBLUE CROSS/BLUE SHIELD
FLDD3444OtherRAILROAD MEDICARE
FLDD3444OtherRAILROAD MEDICARE