Provider Demographics
NPI:1205320025
Name:NEXT GENERATION CHIROPRACTIC & WELLNESS LLC
Entity type:Organization
Organization Name:NEXT GENERATION CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:HEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-885-9229
Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8311
Mailing Address - Country:US
Mailing Address - Phone:407-885-9229
Mailing Address - Fax:407-386-6338
Practice Address - Street 1:8390 CHAMPIONS GATE BLVD STE 108
Practice Address - Street 2:
Practice Address - City:CHAMPIONS GATE
Practice Address - State:FL
Practice Address - Zip Code:33896-8311
Practice Address - Country:US
Practice Address - Phone:407-885-9229
Practice Address - Fax:407-386-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty