Healthcare Provider Details

I. General information

NPI: 1225194665
Provider Name (Legal Business Name): HOLISTIC WELLNESS NOW, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W LAKE MARY BLVD 107
SANFORD FL
32773-5946
US

IV. Provider business mailing address

820 W LAKE MARY BLVD SUITE 107
SANFORD FL
32773-5946
US

V. Phone/Fax

Practice location:
  • Phone: 407-330-0240
  • Fax: 407-330-9432
Mailing address:
  • Phone: 407-330-0240
  • Fax: 407-330-9432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3063
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCH3063
License Number StateFL

VIII. Authorized Official

Name: NEAL WIEDER
Title or Position: PRESIDENT
Credential: DC
Phone: 407-330-0240