Provider Demographics
NPI:1811192693
Name:ADVANTAGE HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:ADVANTAGE HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-343-3959
Mailing Address - Street 1:510 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2126
Mailing Address - Country:US
Mailing Address - Phone:727-343-3959
Mailing Address - Fax:727-343-3125
Practice Address - Street 1:510 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2126
Practice Address - Country:US
Practice Address - Phone:727-343-3959
Practice Address - Fax:727-343-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8105111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9185Medicare ID - Type UnspecifiedFOR ADVANTAGE HWC