Provider Demographics
NPI:1730945700
Name:SURF TO SUMMIT WELLNESS
Entity type:Organization
Organization Name:SURF TO SUMMIT WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-885-8246
Mailing Address - Street 1:11 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3579
Mailing Address - Country:US
Mailing Address - Phone:203-885-8246
Mailing Address - Fax:
Practice Address - Street 1:11 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3579
Practice Address - Country:US
Practice Address - Phone:203-885-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty