=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922513035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERNATIONAL WELLNESS CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2017
-----------------------------------------------------
Last Update Date | 12/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2605 E ATLANTIC BLVD STE 207
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-4948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-220-6799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2605 E ATLANTIC BLVD STE 207
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-4948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-220-6799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GANGPEI ZHOU
-----------------------------------------------------
Credential | AP
-----------------------------------------------------
Telephone | 754-220-6799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP1647
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------