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General NPI Number Information
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NPI Number | 1275164675
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Entity Type | Organization
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Legal Business Name | THE PREMIER WELLNESS CENTER OF PALM BEACH LLC
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 2100 LAKE IDA RD STE 1
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2442
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Country | US
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Telephone | 561-266-3559
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Fax | 561-266-3257
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Provider Business Mailing Address
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Address Line | 2100 LAKE IDA RD STE 1
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2442
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. COLLEEN STEPHANIE DOR
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Credential | DC
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Telephone | 561-266-3559
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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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