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General NPI Number Information
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NPI Number | 1053811968
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Entity Type | Organization
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Legal Business Name | WELLISTICS CONDITIONING CENTER INC
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 7392 NW 35TH TER # 209-210
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City | MIAMI
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State | FL
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Zip | 33122-1271
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Country | US
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Telephone | 786-650-0060
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Fax | 786-536-2503
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Provider Business Mailing Address
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Address Line | 133 JANE LN
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City | SAINT ROSE
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State | LA
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Zip | 70087-3218
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Country | US
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Telephone | 504-224-2400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRISELDA GAZO
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Credential |
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Telephone | 504-994-2243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | FL
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