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General NPI Number Information
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NPI Number | 1588096523
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Entity Type | Organization
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Legal Business Name | BACK AND BODY WELLNESS CENTER INC.
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Dates
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Enumeration Date | 08/01/2013
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 325 CLYDE MORRIS BLVD SUITE 430
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8178
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Country | US
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Telephone | 386-679-7246
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Fax | 386-872-4999
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Provider Business Mailing Address
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Address Line | 325 CLYDE MORRIS BLVD SUITE 430
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8178
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Country | US
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Telephone | 386-679-7246
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Fax | 386-872-4999
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JEFFREY M CULLERS
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Credential | D.C.
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Telephone | 386-679-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CH10828
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License Number State | FL
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