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NPI Code Detail

MEDICARE: ST MARY'S CHIRO MED & WELLNESS CENTER LLC

MEDICARE: ST MARY'S CHIRO MED & WELLNESS CENTER LLC
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1457929200
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST MARY'S CHIRO MED & WELLNESS CENTER LLC
Provider Business Mailing Address
First Line : 3301 W BOYNTON BEACH BLVD STE 12
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33436-4642
Country : US
Telephone Number : 561-810-6270
Fax Number :
Provider Business Practice Location Address
First Line : 3301 W BOYNTON BEACH BLVD STE 12
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33436-4642
Country : US
Telephone Number : 561-810-6270
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MRS. MARIE FLORENCE LUCCIN
Credential :
Telephone Number : 561-574-5774
Provider Enumeration Date : 06/16/2021
Last Update Date : 06/16/2021

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Directions to “ST MARY'S CHIRO MED & WELLNESS CENTER LLC ” Practice Location

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