MEDICARE: FAMILY WELLNESS CENTERS INC

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	208100000X	Physical Medicine & Rehabilitation Physician	OS7123	FL
2	111N00000X	Chiropractor	CH7126	FL

General Provider Information

NPI Number	:	1417142688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY WELLNESS CENTERS INC

Provider Business Mailing Address
First Line	:	4723 W ATLANTIC AVE
Second Line	:	SUITE A-13
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3895
Country	:	US
Telephone Number	:	561-498-1098
Fax Number	:	561-495-2524

Provider Business Practice Location Address
First Line	:	4723 W ATLANTIC AVE
Second Line	:	SUITE A-13
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3895
Country	:	US
Telephone Number	:	561-498-1098
Fax Number	:	561-495-2524

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. DAVID LIVINGSTON
Credential	:	D.C.
Telephone Number	:	561-498-1098

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	08/15/2012

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