Healthcare Provider Details

I. General information

NPI: 1013150804
Provider Name (Legal Business Name): HOFSTEE CHIROPRACTIC & WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 NW SAINT JAMES DR
PORT ST LUCIE FL
34983-1291
US

IV. Provider business mailing address

207 NW SAINT JAMES DR
PORT ST LUCIE FL
34983-1291
US

V. Phone/Fax

Practice location:
  • Phone: 772-878-3240
  • Fax: 772-878-5936
Mailing address:
  • Phone: 772-878-3240
  • Fax: 772-878-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7507
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL BENJAMIN HOFSTEE
Title or Position: OWNER
Credential: D.C.
Phone: 772-878-3240