Healthcare Provider Details

I. General information

NPI: 1114723541
Provider Name (Legal Business Name): FLORIDIAN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W SAMPLE RD STE 240
COCONUT CREEK FL
33073-3473
US

IV. Provider business mailing address

4400 W SAMPLE RD STE 240
COCONUT CREEK FL
33073-3473
US

V. Phone/Fax

Practice location:
  • Phone: 954-591-7757
  • Fax:
Mailing address:
  • Phone: 754-326-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. FRED PATIRICK DELLA JACONO
Title or Position: OWNER
Credential: DC, AP, LMT
Phone: 954-591-7757