MEDICARE: PROWELLNESS, 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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1669139010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROWELLNESS, LLC

Provider Business Mailing Address
First Line	:	2636 ARBOR LN
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-6126
Country	:	US
Telephone Number	:	561-281-1879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2636 ARBOR LN
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-6126
Country	:	US
Telephone Number	:	561-281-1879
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRUCE HABERMAN
Credential	:	DC
Telephone Number	:	561-281-1879

Provider Enumeration Date	:	11/19/2021
Last Update Date	:	11/19/2021

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Directions to “PROWELLNESS, LLC ” Practice Location

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