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General NPI Number Information
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NPI Number | 1619482866
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Entity Type | Organization
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Legal Business Name | MAGNOLIA WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 1318 E 6TH AVE
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City | TALLAHASSEE
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State | FL
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Zip | 32303
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Country | US
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Telephone | 850-656-6606
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Fax | 850-878-5246
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Provider Business Mailing Address
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Address Line | 1318 E 6TH AVE
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6506
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Country | US
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Telephone | 850-656-6606
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Fax | 850-878-5246
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Authorized Official
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Title or Position | OWNER
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Name | MR. ZACHARY RAYMON VERRIER
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Credential | DC
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Telephone | 850-656-6606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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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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