MEDICARE: WELLNESS WAY LAKE MARY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1275228611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS WAY LAKE MARY LLC

Provider Business Mailing Address
First Line	:	580 RINEHART RD STE 100
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1551
Country	:	US
Telephone Number	:	321-695-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 RINEHART RD STE 100
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1551
Country	:	US
Telephone Number	:	321-695-1151
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICK FLYNN
Credential	:	DC
Telephone Number	:	920-429-2844

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	02/05/2025

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Directions to “WELLNESS WAY LAKE MARY LLC ” Practice Location

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