Provider Demographics
NPI:1386207272
Name:CHAMPION WELLNESS CENTERS, FISHAWK, LLC
Entity Type:Organization
Organization Name:CHAMPION WELLNESS CENTERS, FISHAWK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUELER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-409-3304
Mailing Address - Street 1:4341 LYNX PAW TRL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7426
Mailing Address - Country:US
Mailing Address - Phone:813-409-3304
Mailing Address - Fax:
Practice Address - Street 1:4341 LYNX PAW TRL
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7426
Practice Address - Country:US
Practice Address - Phone:813-409-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty