Healthcare Provider Details

I. General information

NPI: 1104150366
Provider Name (Legal Business Name): FLORIDA WELLNESS CENTER OF TALLAHASSEE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 N MONROE ST
TALLAHASSEE FL
32303-4733
US

IV. Provider business mailing address

2339 N MONROE ST
TALLAHASSEE FL
32303-4733
US

V. Phone/Fax

Practice location:
  • Phone: 850-385-6664
  • Fax: 850-385-2403
Mailing address:
  • Phone: 850-385-6664
  • Fax: 850-385-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. REYNALDO PEREZ
Title or Position: PRESIDENT
Credential: D.C.
Phone: 850-385-6664