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General NPI Number Information
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NPI Number | 1699057083
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Entity Type | Organization
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Legal Business Name | WELLINGTON CHIROPRACTIC CENTER OF PBC
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 12797 FOREST HILL BLVD STE B
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City | WELLINGTON
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State | FL
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Zip | 33414-4763
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Country | US
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Telephone | 561-793-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 12797 FOREST HILL BLVD STE B
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City | WELLINGTON
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State | FL
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Zip | 33414-4763
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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 | PRESIDENT
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Name | MATTHEW TAVOLACCI
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Credential |
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Telephone | 561-793-5550
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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 | CH10273
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License Number State | FL
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