Healthcare Provider Details

I. General information

NPI: 1245619253
Provider Name (Legal Business Name): WELLNESS HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N.W. FRONT ST.
MILFORD DE
19963-0001
US

IV. Provider business mailing address

PO BOX 620001
ORLANDO FL
32862-0001
US

V. Phone/Fax

Practice location:
  • Phone: 302-424-4100
  • Fax:
Mailing address:
  • Phone: 352-408-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number20150515160
License Number StateDE

VIII. Authorized Official

Name: PIERRE MOISE
Title or Position: OWNER
Credential:
Phone: 352-408-1090