Provider Demographics
NPI:1447398938
Name:FINE WELLNESS , LLC
Entity Type:Organization
Organization Name:FINE WELLNESS , LLC
Other - Org Name:FINE WELLNESS AND INJURY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-261-5510
Mailing Address - Street 1:675 DOUGLAS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2555
Mailing Address - Country:US
Mailing Address - Phone:407-261-5570
Mailing Address - Fax:407-897-6268
Practice Address - Street 1:675 DOUGLAS AVENUE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2555
Practice Address - Country:US
Practice Address - Phone:407-261-5570
Practice Address - Fax:407-897-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70561AMedicare ID - Type Unspecified