MEDICARE: BEACON CHIRO AND WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1205709896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON CHIRO AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	5517 S WILLIAMSON BLVD STE 305
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-8310
Country	:	US
Telephone Number	:	386-444-7700
Fax Number	:	386-444-7070

Provider Business Practice Location Address
First Line	:	5517 S WILLIAMSON BLVD STE 305
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-8310
Country	:	US
Telephone Number	:	386-444-7700
Fax Number	:	386-444-7070

Authorized Official
Title or Position	:	CLINIC OWNER/CHIROPRACTOR
Name	:	DIONES VALENTIN
Credential	:	DC
Telephone Number	:	787-407-4535

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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