Healthcare Provider Details

I. General information

NPI: 1417142688
Provider Name (Legal Business Name): FAMILY WELLNESS CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 W ATLANTIC AVE SUITE A-13
DELRAY BEACH FL
33445-3895
US

IV. Provider business mailing address

4723 W ATLANTIC AVE SUITE A-13
DELRAY BEACH FL
33445-3895
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-1098
  • Fax: 561-495-2524
Mailing address:
  • Phone: 561-498-1098
  • Fax: 561-495-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7126
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS7123
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID LIVINGSTON
Title or Position: ADMINISTRATOR
Credential: D.C.
Phone: 561-498-1098