Provider Demographics
NPI:1508509779
Name:SEASIDE WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:SEASIDE WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-600-8159
Mailing Address - Street 1:5691 SE CROOKED OAK AVE
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-8319
Mailing Address - Country:US
Mailing Address - Phone:772-600-8159
Mailing Address - Fax:772-600-8159
Practice Address - Street 1:5691 SE CROOKED OAK AVE
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-8319
Practice Address - Country:US
Practice Address - Phone:772-600-8159
Practice Address - Fax:772-600-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty