Provider Demographics
NPI:1619482866
Name:MAGNOLIA WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:MAGNOLIA WELLNESS CENTER, LLC
Other - Org Name:MAGNOLIA WELLNESS CENTER,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:RAYMON
Authorized Official - Last Name:VERRIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-656-6606
Mailing Address - Street 1:1318 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6506
Mailing Address - Country:US
Mailing Address - Phone:850-656-6606
Mailing Address - Fax:850-878-5246
Practice Address - Street 1:1318 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:850-656-6606
Practice Address - Fax:850-878-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty