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General NPI Number Information
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NPI Number | 1720148265
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Entity Type | Organization
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Legal Business Name | WELLNESS EXPERIENCE INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 9825 SW 18TH ST SUITE 200-300
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City | BOCA RATON
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State | FL
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Zip | 33428-6628
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Country | US
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Telephone | 561-883-0090
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Fax | 561-883-0676
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Provider Business Mailing Address
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Address Line | 9825 SW 18TH ST SUITE 200-300
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City | BOCA RATON
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State | FL
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Zip | 33428-6628
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Country | US
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Telephone | 561-883-0090
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Fax | 561-883-0676
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. RANDALL FRANKLIN LAURICH JR.
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Credential | D.C.
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Telephone | 561-441-4221
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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 | CH8047
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License Number State | FL
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