Provider Demographics
NPI:1568807006
Name:FIVE ELEMENT WELLNESS CENTER INC
Entity Type:Organization
Organization Name:FIVE ELEMENT WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:GUSMAO
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-657-8342
Mailing Address - Street 1:7310 W MCNAB RD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5332
Mailing Address - Country:US
Mailing Address - Phone:954-657-8342
Mailing Address - Fax:954-657-8615
Practice Address - Street 1:7310 W MCNAB RD
Practice Address - Street 2:SUITE #107
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5332
Practice Address - Country:US
Practice Address - Phone:954-657-8342
Practice Address - Fax:954-657-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
FLAP2304171100000X
207Q00000X
FLPT1921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty