Provider Demographics
NPI:1154073302
Name:NEUROLOGIC WELLNESS INSTITUTE PLLC
Entity Type:Organization
Organization Name:NEUROLOGIC WELLNESS INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:908-418-0721
Mailing Address - Street 1:7623 NW 122ND DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4542
Mailing Address - Country:US
Mailing Address - Phone:908-418-0721
Mailing Address - Fax:
Practice Address - Street 1:7700 CAMINO REAL STE 320
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5576
Practice Address - Country:US
Practice Address - Phone:908-418-0721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty