Healthcare Provider Details

I. General information

NPI: 1366619983
Provider Name (Legal Business Name): ST CROIX HEALTH & WELLNESS CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 11230
KINGSHILL VI
00850-9618
US

IV. Provider business mailing address

RR 2 BOX 11230
KINGSHILL VI
00850-9618
US

V. Phone/Fax

Practice location:
  • Phone: 340-772-2225
  • Fax: 340-772-5900
Mailing address:
  • Phone: 340-772-2225
  • Fax: 340-772-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number00037
License Number StateVI

VIII. Authorized Official

Name: DR. DEBORAH BOBBITT
Title or Position: PRESIDENT
Credential: D.C.
Phone: 340-772-2225