Provider Demographics
NPI:1013150804
Name:HOFSTEE CHIROPRACTIC & WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:HOFSTEE CHIROPRACTIC & WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HOFSTEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-878-3240
Mailing Address - Street 1:207 NW SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1291
Mailing Address - Country:US
Mailing Address - Phone:772-878-3240
Mailing Address - Fax:772-878-5936
Practice Address - Street 1:207 NW SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1291
Practice Address - Country:US
Practice Address - Phone:772-878-3240
Practice Address - Fax:772-878-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2023OtherMEDICARE P-TAN
FLE2023OtherMEDICARE P-TAN