=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801921770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHOLE HEALTH CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 11/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2819 MAHAN DRIVE STE 102
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-877-8980
-----------------------------------------------------
Fax | 850-671-1796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2819 MAHAN DRIVE STE 102
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-877-8980
-----------------------------------------------------
Fax | 850-671-1796
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | DR. PERI L DWYER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 850-877-8980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH5646
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------