Provider Demographics
NPI:1609269034
Name:ST. LUCIE WELLNESS CENTER, CORP.
Entity Type:Organization
Organization Name:ST. LUCIE WELLNESS CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:D,C,
Authorized Official - Phone:561-684-8774
Mailing Address - Street 1:550 NW UNIVERSITY BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2285
Mailing Address - Country:US
Mailing Address - Phone:772-249-0040
Mailing Address - Fax:772-446-9563
Practice Address - Street 1:550 NW UNIVERSITY BLVD
Practice Address - Street 2:STE 104
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2285
Practice Address - Country:US
Practice Address - Phone:772-249-0040
Practice Address - Fax:772-446-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty