Provider Demographics
NPI:1184894255
Name:NOKOMIS NATURAL HEALING CENTER OF NOKOMIS INC.
Entity type:Organization
Organization Name:NOKOMIS NATURAL HEALING CENTER OF NOKOMIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:GONSALVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-488-2008
Mailing Address - Street 1:303 S. TAMIAMI TR.
Mailing Address - Street 2:UNIT F
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275
Mailing Address - Country:US
Mailing Address - Phone:941-488-2008
Mailing Address - Fax:
Practice Address - Street 1:303 TAMIAMI TRL S
Practice Address - Street 2:UNIT F
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3104
Practice Address - Country:US
Practice Address - Phone:941-488-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty