Provider Demographics
NPI:1205087749
Name:TREASURE COAST INJURY AND WELLNESS CENTRE
Entity type:Organization
Organization Name:TREASURE COAST INJURY AND WELLNESS CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-978-9916
Mailing Address - Street 1:600 N US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-3072
Mailing Address - Country:US
Mailing Address - Phone:772-978-9916
Mailing Address - Fax:772-978-9918
Practice Address - Street 1:600 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-3072
Practice Address - Country:US
Practice Address - Phone:772-978-9916
Practice Address - Fax:772-978-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4024Medicare PIN