Provider Demographics
NPI:1821027053
Name:WELLNESS EXPERIENCE OF WELLINGTON INC
Entity Type:Organization
Organization Name:WELLNESS EXPERIENCE OF WELLINGTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAURICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:561-333-5351
Mailing Address - Street 1:1400 CORPORATE CENTER WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-2210
Mailing Address - Country:US
Mailing Address - Phone:561-333-5351
Mailing Address - Fax:561-333-5374
Practice Address - Street 1:1400 CORPORATE CENTER WAY STE 120
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-2210
Practice Address - Country:US
Practice Address - Phone:561-333-5351
Practice Address - Fax:561-333-5374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS EXPERIENCE OF WELLINGTON INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70234ZMedicare PIN