Provider Demographics
NPI:1740557222
Name:PREMIER HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:PREMIER HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RUSZKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-717-4200
Mailing Address - Street 1:4010 NW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5721
Mailing Address - Country:US
Mailing Address - Phone:954-717-4200
Mailing Address - Fax:954-717-4459
Practice Address - Street 1:4010 NW 34TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5721
Practice Address - Country:US
Practice Address - Phone:954-717-4200
Practice Address - Fax:954-717-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM28102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty