Provider Demographics
NPI:1083096648
Name:DR. TRISTAN MICELI, PLLC
Entity Type:Organization
Organization Name:DR. TRISTAN MICELI, PLLC
Other - Org Name:PURE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICELI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-469-6699
Mailing Address - Street 1:129 S STATE ROAD 7 STE 402
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4379
Mailing Address - Country:US
Mailing Address - Phone:561-469-6699
Mailing Address - Fax:561-469-6636
Practice Address - Street 1:129 S STATE ROAD 7 STE 402
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4379
Practice Address - Country:US
Practice Address - Phone:561-469-6699
Practice Address - Fax:561-469-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty