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General NPI Number Information
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NPI Number | 1932515889
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Entity Type | Organization
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Legal Business Name | WHITE SANDS WELLNESS
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 1820 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-1301
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Country | US
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Telephone | 954-641-5366
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Fax |
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Provider Business Mailing Address
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Address Line | 3471 N FEDERAL HWY SUITE 402
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City | OAKLAND PARK
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State | FL
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Zip | 33306-1019
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Country | US
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Telephone | 954-641-5366
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC LEON
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Credential | D.C.
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Telephone | 954-641-5366
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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 | CH8296
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License Number State | FL
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