Healthcare Provider Details

I. General information

NPI: 1497207963
Provider Name (Legal Business Name): JIBE WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 N MILITARY TRL SUITE 301
BOCA RATON FL
33431-6361
US

IV. Provider business mailing address

3010 N MILITARY TRL SUITE 301
BOCA RATON FL
33431-6361
US

V. Phone/Fax

Practice location:
  • Phone: 888-769-0474
  • Fax:
Mailing address:
  • Phone: 888-769-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8940
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES VIRGILIO
Title or Position: PRESIDENT
Credential: DC
Phone: 877-708-5423