Provider Demographics
NPI:1225194665
Name:HOLISTIC WELLNESS NOW, PA
Entity Type:Organization
Organization Name:HOLISTIC WELLNESS NOW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-330-0240
Mailing Address - Street 1:820 W LAKE MARY BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5946
Mailing Address - Country:US
Mailing Address - Phone:407-330-0240
Mailing Address - Fax:407-330-9432
Practice Address - Street 1:820 W LAKE MARY BLVD
Practice Address - Street 2:107
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5946
Practice Address - Country:US
Practice Address - Phone:407-330-0240
Practice Address - Fax:407-330-9432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3063111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1194299950OtherSTATE OF OHIO WORK COMP
TN0166185OtherBCBS OF TN
OH1194299950OtherSTATE OF OHIO WORK COMP