Provider Demographics
NPI:1922572031
Name:WYNWELLNESS LLC
Entity Type:Organization
Organization Name:WYNWELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SAMPERISI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-899-0595
Mailing Address - Street 1:56 NE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4413
Mailing Address - Country:US
Mailing Address - Phone:631-338-2273
Mailing Address - Fax:
Practice Address - Street 1:56 NE 29TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4413
Practice Address - Country:US
Practice Address - Phone:631-338-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty