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General NPI Number Information
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NPI Number | 1861632135
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Entity Type | Organization
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Legal Business Name | GINGRAS WELLNESS CENTER LLC
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 720 E 3RD AVE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-3102
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Country | US
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Telephone | 386-423-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 720 E 3RD AVE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-3102
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Country | US
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Telephone | 386-423-2225
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MICHELLE GINGRAS
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Credential | D.C.
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Telephone | 386-423-2225
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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 | CH8584
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License Number State | FL
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