Healthcare Provider Details

I. General information

NPI: 1477030732
Provider Name (Legal Business Name): HARBOUR MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 SE OCEAN BLVD
STUART FL
34996-2651
US

IV. Provider business mailing address

1411 SE OCEAN BLVD
STUART FL
34996-2651
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-1101
  • Fax: 772-781-1141
Mailing address:
  • Phone: 772-781-1101
  • Fax: 772-781-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7269
License Number StateFL

VIII. Authorized Official

Name: WILLIAM J WIEDNER
Title or Position: PROPRIETOR
Credential: DC
Phone: 772-781-1101