Healthcare Provider Details

I. General information

NPI: 1821027053
Provider Name (Legal Business Name): WELLNESS EXPERIENCE OF WELLINGTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11596 PIERSON RD UNIT 5
WELLINGTON FL
33414-8770
US

IV. Provider business mailing address

11596 PIERSON RD UNIT 5
WELLINGTON FL
33414-8770
US

V. Phone/Fax

Practice location:
  • Phone: 561-333-5351
  • Fax: 561-333-5374
Mailing address:
  • Phone: 561-333-5351
  • Fax: 561-333-5374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8047
License Number StateFL

VIII. Authorized Official

Name: DR. RANDALL F LAURICH JR.
Title or Position: OWNER
Credential: DC
Phone: 561-333-5351