Provider Demographics
NPI:1275164675
Name:THE PREMIER WELLNESS CENTER OF PALM BEACH LLC
Entity Type:Organization
Organization Name:THE PREMIER WELLNESS CENTER OF PALM BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:DOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-266-3559
Mailing Address - Street 1:2100 LAKE IDA RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 LAKE IDA RD STE 1
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2442
Practice Address - Country:US
Practice Address - Phone:561-266-3559
Practice Address - Fax:561-266-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty