Provider Demographics
NPI:1790028645
Name:TRINITY FAMILY CHIROPRACTIC AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:TRINITY FAMILY CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:JUSTINE PANZARELLA
Authorized Official - Last Name:PREIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-956-4708
Mailing Address - Street 1:116 DUNLAWTON BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-2607
Mailing Address - Country:US
Mailing Address - Phone:386-756-9484
Mailing Address - Fax:386-756-9855
Practice Address - Street 1:116 DUNLAWTON BLVD
Practice Address - Street 2:STE 2
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118-2607
Practice Address - Country:US
Practice Address - Phone:386-756-9484
Practice Address - Fax:386-756-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty