Provider Demographics
NPI:1619900495
Name:DISCOVER CHIROPRACTIC AND WELLNESS P A
Entity Type:Organization
Organization Name:DISCOVER CHIROPRACTIC AND WELLNESS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/DC
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:KULJU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-749-8552
Mailing Address - Street 1:1850 RYE RD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212
Mailing Address - Country:US
Mailing Address - Phone:941-749-8552
Mailing Address - Fax:941-749-8553
Practice Address - Street 1:1850 RYE RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212
Practice Address - Country:US
Practice Address - Phone:941-749-8552
Practice Address - Fax:941-749-8553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
FLCH7938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87968Medicare UPIN