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General NPI Number Information
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NPI Number | 1194077347
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Entity Type | Organization
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Legal Business Name | PREMIER WELLNESS CENTERS
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 7043 S US HIGHWAY 1
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-1401
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Country | US
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Telephone | 772-344-1222
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Fax | 772-344-1220
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Provider Business Mailing Address
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Address Line | 7043 S US HIGHWAY 1
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-1401
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Country | US
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Telephone | 772-344-1222
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Fax | 772-344-1220
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Authorized Official
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Title or Position | OWNER
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Name | MR. JON PAUL FRITZ
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Credential | DC
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Telephone | 772-344-1222
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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 | CH10181
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License Number State | ZZ
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