Healthcare Provider Details

I. General information

NPI: 1053071779
Provider Name (Legal Business Name): ABC WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 NW 12TH ST
GAINESVILLE FL
32609-3473
US

IV. Provider business mailing address

2202 NW 12TH ST
GAINESVILLE FL
32609-3473
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1320
  • Fax:
Mailing address:
  • Phone: 352-376-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN BYRON
Title or Position: PARTNER
Credential: DC
Phone: 352-376-1320