Provider Demographics
NPI:1467065771
Name:FANNA WELLNESS LLC
Entity Type:Organization
Organization Name:FANNA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-657-9619
Mailing Address - Street 1:4445 E BAY DR STE 302
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6865
Mailing Address - Country:US
Mailing Address - Phone:727-657-9619
Mailing Address - Fax:
Practice Address - Street 1:4445 E BAY DR STE 302
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6865
Practice Address - Country:US
Practice Address - Phone:727-657-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty