Provider Demographics
NPI:1275228611
Name:WELLNESS WAY LAKE MARY LLC
Entity Type:Organization
Organization Name:WELLNESS WAY LAKE MARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-429-2844
Mailing Address - Street 1:580 RHINEHART RD
Mailing Address - Street 2:UNIT 100
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1551
Mailing Address - Country:US
Mailing Address - Phone:321-695-1151
Mailing Address - Fax:
Practice Address - Street 1:580 RHINEHART RD
Practice Address - Street 2:UNIT 100
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1551
Practice Address - Country:US
Practice Address - Phone:321-695-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty