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General NPI Number Information
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NPI Number | 1447599907
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Entity Type | Organization
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Legal Business Name | INNER WELLNESS CENTERS OF FLORIDA, LLC
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 6837 S FEDERAL HWY
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-1443
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Country | US
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Telephone | 772-577-6640
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Fax | 772-494-7268
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Provider Business Mailing Address
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Address Line | 2202 SW NEWPORT ISLES BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-4577
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Country | US
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Telephone | 772-577-6640
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SUSAN PARKER SANDERS
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Credential | DC
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Telephone | 772-577-6640
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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 | CH9771
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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