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General NPI Number Information
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NPI Number | 1205320025
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Entity Type | Organization
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Legal Business Name | NEXT GENERATION CHIROPRACTIC & WELLNESS LLC
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 8390 CHAMPIONS GATE BLVD STE 108
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896-8311
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Country | US
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Telephone | 407-885-9229
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Fax | 407-386-6338
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Provider Business Mailing Address
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Address Line | 8390 CHAMPIONS GATE BLVD STE 108
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896-8311
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Country | US
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Telephone | 407-885-9229
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Fax | 407-386-6338
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. AUDRA VIRGINIA HEWETT
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Credential | DC
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Telephone | 407-885-9229
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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 | CH12241
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License Number State | FL
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