Provider Demographics
NPI:1538498985
Name:ST. PETE HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:ST. PETE HEALTH ASSOCIATES
Other - Org Name:B'WEL CHIROPRACTIC & HEALTH ASSOCIATES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENZSCHAWEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-202-7250
Mailing Address - Street 1:2201 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4236
Mailing Address - Country:US
Mailing Address - Phone:727-202-7250
Mailing Address - Fax:727-207-7256
Practice Address - Street 1:2201 58TH ST N
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4236
Practice Address - Country:US
Practice Address - Phone:727-202-7250
Practice Address - Fax:727-207-7256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. PETE HEALTH ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-14
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4030-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104249200Medicaid
WI38955100Medicaid