Provider Demographics
NPI:1851765408
Name:HOLLYWOOD WELLNESS CLINIC INC
Entity Type:Organization
Organization Name:HOLLYWOOD WELLNESS CLINIC INC
Other - Org Name:ELITE SPINE OF HOLLYWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-890-6040
Mailing Address - Street 1:1336 NW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1500
Mailing Address - Country:US
Mailing Address - Phone:305-890-6040
Mailing Address - Fax:
Practice Address - Street 1:3107 STIRLING RD
Practice Address - Street 2:SUITE 206
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6565
Practice Address - Country:US
Practice Address - Phone:954-835-5644
Practice Address - Fax:954-283-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty