Healthcare Provider Details

I. General information

NPI: 1205709896
Provider Name (Legal Business Name): BEACON CHIRO AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 S WILLIAMSON BLVD STE 305
PORT ORANGE FL
32128-8310
US

IV. Provider business mailing address

5517 S WILLIAMSON BLVD STE 305
PORT ORANGE FL
32128-8310
US

V. Phone/Fax

Practice location:
  • Phone: 386-444-7700
  • Fax: 386-444-7070
Mailing address:
  • Phone: 386-444-7700
  • Fax: 386-444-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIONES VALENTIN
Title or Position: CLINIC OWNER/CHIROPRACTOR
Credential: DC
Phone: 787-407-4535