Provider Demographics
NPI:1457112013
Name:CHIROPRACTIC ENVY HEALTH & WELLNESS
Entity Type:Organization
Organization Name:CHIROPRACTIC ENVY HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-470-8339
Mailing Address - Street 1:8095 SPYGLASS HILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8290
Mailing Address - Country:US
Mailing Address - Phone:321-329-5444
Mailing Address - Fax:321-999-9411
Practice Address - Street 1:8095 SPYGLASS HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8290
Practice Address - Country:US
Practice Address - Phone:321-329-5444
Practice Address - Fax:321-999-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty