Provider Demographics
NPI:1881232114
Name:INTEGRATIVE WELLNESS CENTER OF JACKSONVILLE
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS CENTER OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:904-800-5588
Mailing Address - Street 1:1153 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3445
Mailing Address - Country:US
Mailing Address - Phone:904-800-5588
Mailing Address - Fax:
Practice Address - Street 1:1153 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3445
Practice Address - Country:US
Practice Address - Phone:904-800-5588
Practice Address - Fax:904-800-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty