Healthcare Provider Details

I. General information

NPI: 1760711246
Provider Name (Legal Business Name): FUNK CONSULTING & PROMOTIONAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 US HIGHWAY 1 SUITE 203
SEBASTIAN FL
32958-1611
US

IV. Provider business mailing address

1511 US HIGHWAY 1 SUITE 203
SEBASTIAN FL
32958-1611
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-3773
  • Fax: 772-581-3746
Mailing address:
  • Phone: 772-581-3773
  • Fax: 772-581-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6567
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2243
License Number StateFL

VIII. Authorized Official

Name: DR. LELAND WELCH FUNK
Title or Position: OWNER
Credential: DC, CCEP, AP, DOM
Phone: 772-581-3773