Healthcare Provider Details

I. General information

NPI: 1689018681
Provider Name (Legal Business Name): TOTAL HEALTH ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SE GOLDTREE DR 207
PORT SAINT LUCIE FL
34952-7582
US

IV. Provider business mailing address

1400 SE GOLDTREE DR 207
PORT SAINT LUCIE FL
34952-7582
US

V. Phone/Fax

Practice location:
  • Phone: 772-777-2836
  • Fax: 772-777-2837
Mailing address:
  • Phone: 772-777-2836
  • Fax: 772-777-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANE DONALD WHITELEY
Title or Position: PRESIDENT
Credential: DC
Phone: 772-777-2836