Healthcare Provider Details

I. General information

NPI: 1265629745
Provider Name (Legal Business Name): ABSOLUTE WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

641 W LUMSDEN RD
BRANDON FL
33511-5911
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-5413
  • Fax: 813-643-1457
Mailing address:
  • Phone: 813-654-5413
  • Fax: 813-643-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH6698
License Number StateFL

VIII. Authorized Official

Name: MS. LINETTE LEE HENRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 813-654-5413