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General NPI Number Information
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NPI Number | 1548311210
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Entity Type | Organization
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Legal Business Name | LIFESOURCE HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 3842 FLATIRON LOOP
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7824
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Country | US
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Telephone | 813-929-3700
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Fax | 813-929-3711
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Provider Business Mailing Address
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Address Line | 3842 FLATIRON LOOP
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7824
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Country | US
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Telephone | 813-929-3700
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Fax | 813-929-3711
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN F BERNS
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Credential | DC
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Telephone | 813-929-3700
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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 | CH8992
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License Number State | FL
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