MEDICARE: WHOLE HEALTH CLINIC 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	111N00000X	Chiropractor
2	111N00000X	Chiropractor	CH5646	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38125	OTHER	FL	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801921770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE HEALTH CLINIC INC

Provider Business Mailing Address
First Line	:	2819 MAHAN DRIVE
Second Line	:	STE 102
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308
Country	:	US
Telephone Number	:	850-877-8980
Fax Number	:	850-671-1796

Provider Business Practice Location Address
First Line	:	2819 MAHAN DRIVE
Second Line	:	STE 102
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308
Country	:	US
Telephone Number	:	850-877-8980
Fax Number	:	850-671-1796

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DR. PERI L DWYER
Credential	:	D.C.
Telephone Number	:	850-877-8980

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	11/20/2009

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Directions to “WHOLE HEALTH CLINIC INC ” Practice Location

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