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General NPI Number Information
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NPI Number | 1902237415
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Entity Type | Organization
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Legal Business Name | PALMETTO WELLNESS CLINIC, INC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 1840 W 49TH ST SUITE 302
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City | HIALEAH
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State | FL
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Zip | 33012-2942
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Country | US
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Telephone | 305-819-0380
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 W 49TH ST SUITE 302
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City | HIALEAH
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State | FL
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Zip | 33012-2942
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Country | US
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Telephone | 305-819-0380
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OSCAR MOLINA
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Credential |
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Telephone | 305-710-0395
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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 | CH10680
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License Number State | FL
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