Provider Demographics
NPI:1578787453
Name:FLORIDA WELLNESS & REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:FLORIDA WELLNESS & REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CERECEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PA
Authorized Official - Phone:305-246-0056
Mailing Address - Street 1:207 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6018
Mailing Address - Country:US
Mailing Address - Phone:305-246-0056
Mailing Address - Fax:305-246-0093
Practice Address - Street 1:207 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6018
Practice Address - Country:US
Practice Address - Phone:305-246-0056
Practice Address - Fax:305-246-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty