Healthcare Provider Details

I. General information

NPI: 1154073302
Provider Name (Legal Business Name): NEUROLOGIC WELLNESS INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 CAMINO REAL STE 320
BOCA RATON FL
33433-5576
US

IV. Provider business mailing address

7623 NW 122ND DR
PARKLAND FL
33076-4542
US

V. Phone/Fax

Practice location:
  • Phone: 908-418-0721
  • Fax:
Mailing address:
  • Phone: 908-418-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KELSEY BRENNER
Title or Position: OWNER
Credential: DC, DACNB
Phone: 908-418-0721