Provider Demographics
NPI:1164671400
Name:GULF COAST WELLNESS CENTER INC
Entity Type:Organization
Organization Name:GULF COAST WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-277-1655
Mailing Address - Street 1:12811 KENWOOD LN
Mailing Address - Street 2:SUITE 118
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5667
Mailing Address - Country:US
Mailing Address - Phone:239-277-1655
Mailing Address - Fax:239-939-7020
Practice Address - Street 1:12811 KENWOOD LN
Practice Address - Street 2:SUITE 118
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5667
Practice Address - Country:US
Practice Address - Phone:239-277-1655
Practice Address - Fax:239-939-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty