Healthcare Provider Details

I. General information

NPI: 1518302116
Provider Name (Legal Business Name): MASTER HOLISTIC FORMULATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 S MILITARY TRL STE 104
DELRAY BEACH FL
33484-2600
US

IV. Provider business mailing address

601 N CONGRESS AVE STE 415
DELRAY BEACH FL
33445-4640
US

V. Phone/Fax

Practice location:
  • Phone: 866-211-5538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State

VIII. Authorized Official

Name: MARK GERHARDT
Title or Position: CHEIF EXECUTIVE OFFICER
Credential:
Phone: 866-211-5538