Provider Demographics
NPI:1275798555
Name:WELLNESS ONE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WELLNESS ONE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARKHURST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-447-9930
Mailing Address - Street 1:2 OFFICE PARK DR
Mailing Address - Street 2:STE. A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3854
Mailing Address - Country:US
Mailing Address - Phone:386-447-9930
Mailing Address - Fax:386-447-9931
Practice Address - Street 1:2 OFFICE PARK DR
Practice Address - Street 2:STE. A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3854
Practice Address - Country:US
Practice Address - Phone:386-447-9930
Practice Address - Fax:386-447-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty