Healthcare Provider Details

I. General information

NPI: 1508141102
Provider Name (Legal Business Name): IMMOKALEE WELLNESS CHIROPRACTIC CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13260 IMMOKALEE RD SUITE #2
NAPLES FL
34120-1788
US

IV. Provider business mailing address

13260 IMMOKALEE RD SUITE #2
NAPLES FL
34120-1788
US

V. Phone/Fax

Practice location:
  • Phone: 239-692-8591
  • Fax: 239-692-8594
Mailing address:
  • Phone: 239-692-8591
  • Fax: 239-692-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRIETTA CECCARELLI
Title or Position: CHIROPRACTOR
Credential: D.C
Phone: 239-692-8591