MEDICARE: PONTE VEDRA WELLNESS CENTER 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	111NN0400X	Neurology Chiropractor	CH8499	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DD3444	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88720	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1548438385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PONTE VEDRA WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	100 CORRIDOR RD S
Second Line	:	STE 220
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082
Country	:	US
Telephone Number	:	904-273-2691
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CORRIDOR RD S
Second Line	:	STE 220
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082
Country	:	US
Telephone Number	:	904-273-2691
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERIKA R HAMER
Credential	:	D.C.
Telephone Number	:	904-273-2691

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	03/04/2026

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Directions to “PONTE VEDRA WELLNESS CENTER INC ” Practice Location

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