Healthcare Provider Details

I. General information

NPI: 1568807006
Provider Name (Legal Business Name): FIVE ELEMENT WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 W MCNAB RD SUITE #107
TAMARAC FL
33321-5332
US

IV. Provider business mailing address

7310 W MCNAB RD SUITE #107
TAMARAC FL
33321-5332
US

V. Phone/Fax

Practice location:
  • Phone: 954-657-8342
  • Fax: 954-657-8615
Mailing address:
  • Phone: 954-657-8342
  • Fax: 954-657-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2304
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1921
License Number StateFL

VIII. Authorized Official

Name: MRS. MONIQUE GUSMAO BAIN
Title or Position: OWNER/PHYSICIAN
Credential: AP
Phone: 954-657-8342