Healthcare Provider Details

I. General information

NPI: 1619692704
Provider Name (Legal Business Name): CHIROPRACTIC HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10088 W INDIANTOWN RD STE B
JUPITER FL
33478
US

IV. Provider business mailing address

6199 RIVERWALK LN UNIT 5
JUPITER FL
33458-7906
US

V. Phone/Fax

Practice location:
  • Phone: 646-463-4031
  • Fax: 561-626-6733
Mailing address:
  • Phone: 646-463-4031
  • Fax: 561-626-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELLA KALANTAROV
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 646-463-4031