Healthcare Provider Details

I. General information

NPI: 1629980396
Provider Name (Legal Business Name): EMERALD ISLE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 PARK ST
DUNEDIN FL
34698-7016
US

IV. Provider business mailing address

557 PARK ST
DUNEDIN FL
34698-7016
US

V. Phone/Fax

Practice location:
  • Phone: 727-314-2663
  • Fax: 888-394-4159
Mailing address:
  • Phone: 727-314-2663
  • Fax: 888-394-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PETERSON
Title or Position: CEO/CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 813-727-8505