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General NPI Number Information
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NPI Number | 1467065771
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Entity Type | Organization
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Legal Business Name | FANNA WELLNESS LLC
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 4445 E BAY DR STE 302
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City | CLEARWATER
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State | FL
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Zip | 33764-6865
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Country | US
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Telephone | 727-657-9619
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 E BAY DR STE 302
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City | CLEARWATER
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State | FL
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Zip | 33764-6865
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Country | US
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Telephone | 727-657-9619
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | FAN YANG
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Credential | D.C.
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Telephone | 727-657-9619
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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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