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General NPI Number Information
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NPI Number | 1144608969
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Entity Type | Organization
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Legal Business Name | OCEANSIDE WELLNESS PLLC
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 3516 S ATLANTIC AVENUE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-3628
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Country | US
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Telephone | 386-235-4412
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Fax | 386-410-2918
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Provider Business Mailing Address
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Address Line | 3516 S ATLANTIC AVENUE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-3628
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Country | US
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Telephone | 386-235-4412
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Fax | 863-816-5865
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | PHYLEISCHA OWEN
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Credential |
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Telephone | 407-312-4613
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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 | CH10756
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License Number State | FL
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