Provider Demographics
NPI:1548454002
Name:NATURAL WELLNESS CENTER
Entity type:Organization
Organization Name:NATURAL WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-660-8520
Mailing Address - Street 1:1701 SHEPHERD RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2179
Mailing Address - Country:US
Mailing Address - Phone:863-646-5575
Mailing Address - Fax:863-648-4465
Practice Address - Street 1:1701 SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-2179
Practice Address - Country:US
Practice Address - Phone:863-646-5575
Practice Address - Fax:863-648-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 00008609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88859WMedicare PIN
FLU96678Medicare UPIN