Provider Demographics
NPI:1245335264
Name:ATLANTIC WELLNESS CENTER
Entity type:Organization
Organization Name:ATLANTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-424-9977
Mailing Address - Street 1:225 N CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5239
Mailing Address - Country:US
Mailing Address - Phone:386-424-9977
Mailing Address - Fax:386-423-3899
Practice Address - Street 1:225 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5239
Practice Address - Country:US
Practice Address - Phone:386-424-9977
Practice Address - Fax:386-423-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6443111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380098900Medicaid
FLU30178Medicare UPIN
FL22748Medicare ID - Type Unspecified