Healthcare Provider Details

I. General information

NPI: 1346420627
Provider Name (Legal Business Name): APOPKA WELLNESS CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 N PARK AVE
APOPKA FL
32712-4152
US

IV. Provider business mailing address

424 N PARK AVE
APOPKA FL
32712-4152
US

V. Phone/Fax

Practice location:
  • Phone: 407-886-0611
  • Fax: 407-886-2817
Mailing address:
  • Phone: 407-886-0611
  • Fax: 407-886-2817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0002710
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME56047
License Number StateFL

VIII. Authorized Official

Name: DR. ADLAI STEVEN GREEN
Title or Position: BOSS
Credential: D.C.
Phone: 407-886-0611