Provider Demographics
NPI:1619371390
Name:JACKSONVILLE WELLNESS CENTER
Entity Type:Organization
Organization Name:JACKSONVILLE WELLNESS CENTER
Other - Org Name:FAMILY ACUPUNCTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XIAOLU
Authorized Official - Middle Name:
Authorized Official - Last Name:LUO
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:904-880-1889
Mailing Address - Street 1:10175 FORTUNE PKWY
Mailing Address - Street 2:UNIT 304
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6746
Mailing Address - Country:US
Mailing Address - Phone:904-880-1889
Mailing Address - Fax:904-239-3028
Practice Address - Street 1:10175 FORTUNE PKWY
Practice Address - Street 2:UNIT 304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6746
Practice Address - Country:US
Practice Address - Phone:904-880-1889
Practice Address - Fax:904-239-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty