Provider Demographics
NPI:1396025219
Name:WETTER SPINE AND WELLNESS CENTERSLLC
Entity Type:Organization
Organization Name:WETTER SPINE AND WELLNESS CENTERSLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-473-4218
Mailing Address - Street 1:3408 AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-1954
Mailing Address - Country:US
Mailing Address - Phone:772-473-4318
Mailing Address - Fax:
Practice Address - Street 1:3408 AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-1954
Practice Address - Country:US
Practice Address - Phone:772-473-4218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty