MEDICARE: APOPKA WELLNESS CENTER,INC.

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	207Q00000X	Family Medicine Physician	ME56047	FL
2	111N00000X	Chiropractor	CH0002710	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346420627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOPKA WELLNESS CENTER,INC.

Provider Business Mailing Address
First Line	:	424 N PARK AVE
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-4152
Country	:	US
Telephone Number	:	407-886-0611
Fax Number	:	407-886-2817

Provider Business Practice Location Address
First Line	:	424 N PARK AVE
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-4152
Country	:	US
Telephone Number	:	407-886-0611
Fax Number	:	407-886-2817

Authorized Official
Title or Position	:	BOSS
Name	:	DR. ADLAI STEVEN GREEN
Credential	:	D.C.
Telephone Number	:	407-886-0611

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	10/15/2010

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Directions to “APOPKA WELLNESS CENTER,INC. ” Practice Location

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