MEDICARE: DEFINE WELLNESS CHIROPRACTIC AND FUNCTIONAL MEDICINE

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	:	1285189860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEFINE WELLNESS CHIROPRACTIC AND FUNCTIONAL MEDICINE

Provider Business Mailing Address
First Line	:	6702 ARCHING BRANCH CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-8448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 RIVERSIDE AVE
Second Line	:	SUITE 300
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4443
Country	:	US
Telephone Number	:	904-321-9418
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRET TOFTNESS
Credential	:
Telephone Number	:	715-419-0535

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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