Provider Demographics
NPI:1629282256
Name:C.C. WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:C.C. WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-772-2452
Mailing Address - Street 1:2328 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1459
Mailing Address - Country:US
Mailing Address - Phone:239-772-2452
Mailing Address - Fax:
Practice Address - Street 1:2328 HANCOCK BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1459
Practice Address - Country:US
Practice Address - Phone:239-772-2452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6817111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty