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General NPI Number Information
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NPI Number | 1629695572
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Entity Type | Organization
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Legal Business Name | NUWAVE HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 235 HATTERAS AVE STE 100
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City | CLERMONT
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State | FL
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Zip | 34711-7401
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Country | US
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Telephone | 352-404-8929
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Fax | 352-404-6519
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Provider Business Mailing Address
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Address Line | 3018 EAGLET LOOP
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City | ORLANDO
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State | FL
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Zip | 32837-6929
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EUSEBIO DESROSIERS
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Credential | D.C
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Telephone | 407-300-2180
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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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