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General NPI Number Information
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NPI Number | 1881418911
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Entity Type | Organization
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Legal Business Name | OCEAN PARK WELLNESS LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 5656 ISABELLE AVE STE 6
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City | PORT ORANGE
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State | FL
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Zip | 32127-6255
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Country | US
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Telephone | 386-847-9797
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Fax |
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Provider Business Mailing Address
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Address Line | 5656 ISABELLE AVE STE 6
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City | PORT ORANGE
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State | FL
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Zip | 32127-6255
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Country | US
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Telephone | 386-847-9797
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. LANIKA BUCHANAN
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Credential | ND, AP
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Telephone | 386-847-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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