Provider Demographics
NPI:1467757393
Name:PARAMOUNT WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:PARAMOUNT WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR (CHIROPRACTOR)
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACK
Authorized Official - Suffix:
Authorized Official - Credentials:JAMES E JACK DC
Authorized Official - Phone:954-630-1616
Mailing Address - Street 1:2745 E. OAKLAND PARK BLVD.
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306
Mailing Address - Country:US
Mailing Address - Phone:954-630-1616
Mailing Address - Fax:954-656-1365
Practice Address - Street 1:2745 E. OAKLAND PARK BLVD.
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306
Practice Address - Country:US
Practice Address - Phone:954-630-1616
Practice Address - Fax:954-656-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89576ZMedicare UPIN
FL89576ZMedicare PIN