Provider Demographics
NPI:1790053585
Name:JOSEPH V TUTTOLOMONDO, P.A.
Entity Type:Organization
Organization Name:JOSEPH V TUTTOLOMONDO, P.A.
Other - Org Name:WYCLIFFE HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:TUTTOLOMONDO
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:561-868-0321
Mailing Address - Street 1:4095 STATE ROAD 7
Mailing Address - Street 2:SUITE I
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8179
Mailing Address - Country:US
Mailing Address - Phone:561-868-0321
Mailing Address - Fax:561-868-5707
Practice Address - Street 1:4095 STATE ROAD 7
Practice Address - Street 2:SUITE I
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-8179
Practice Address - Country:US
Practice Address - Phone:561-868-0321
Practice Address - Fax:561-868-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55834Medicare PIN