Healthcare Provider Details

I. General information

NPI: 1245335264
Provider Name (Legal Business Name): ATLANTIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N CAUSEWAY
NEW SMYRNA BEACH FL
32169-5239
US

IV. Provider business mailing address

225 N CAUSEWAY
NEW SMYRNA BEACH FL
32169-5239
US

V. Phone/Fax

Practice location:
  • Phone: 386-424-9977
  • Fax: 386-423-3899
Mailing address:
  • Phone: 386-424-9977
  • Fax: 386-423-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH6443
License Number StateFL

VIII. Authorized Official

Name: DR. KEITH J ENGLER
Title or Position: OWNER
Credential: DC
Phone: 386-424-9977