Provider Demographics
NPI:1205937364
Name:HEALTH SOLUTIONS WELLNESS CENTER LLC
Entity type:Organization
Organization Name:HEALTH SOLUTIONS WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:SOUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-717-7553
Mailing Address - Street 1:1514 S ALEXANDER ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-8414
Mailing Address - Country:US
Mailing Address - Phone:813-717-7553
Mailing Address - Fax:813-717-7593
Practice Address - Street 1:1514 S ALEXANDER ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-8414
Practice Address - Country:US
Practice Address - Phone:813-717-7553
Practice Address - Fax:813-717-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-8722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37211OtherBCBS
FL695129OtherUNITED HEALTH CARE ACN
FL=========OtherTAX IDENTIFICATION
FL37211ZMedicare PIN