Provider Demographics
NPI:1508223280
Name:WOLOSHEN WELLNESS CENTER
Entity Type:Organization
Organization Name:WOLOSHEN WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLOSHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-254-3900
Mailing Address - Street 1:501 N HOWARD AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 N HOWARD AVE
Practice Address - Street 2:STE 130
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1213
Practice Address - Country:US
Practice Address - Phone:813-254-3900
Practice Address - Fax:813-254-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH005533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty