Healthcare Provider Details

I. General information

NPI: 1871762104
Provider Name (Legal Business Name): LOVING CHIROPRACTIC AND WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SE MONTEREY RD
STUART FL
34994-4410
US

IV. Provider business mailing address

630 SE MONTEREY RD
STUART FL
34994-4410
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-3313
  • Fax: 772-219-3314
Mailing address:
  • Phone: 772-219-3313
  • Fax: 772-219-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT5764
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8004
License Number StateFL

VIII. Authorized Official

Name: DR. MARK HAMMOND LOVING
Title or Position: OWNER/PRESIDENT
Credential: MSPT,DC
Phone: 772-219-3313