Healthcare Provider Details

I. General information

NPI: 1942342639
Provider Name (Legal Business Name): CARE CHIROPRACTIC & WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 W NEW HAVEN AVE
W MELBOURNE FL
32904-3864
US

IV. Provider business mailing address

2104 W NEW HAVEN AVE
W MELBOURNE FL
32904-3864
US

V. Phone/Fax

Practice location:
  • Phone: 321-728-1387
  • Fax: 321-728-1386
Mailing address:
  • Phone: 321-728-1387
  • Fax: 321-728-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN PATRICK WALSH
Title or Position: PRESIDENT
Credential:
Phone: 321-728-1387