Provider Demographics
NPI:1457929200
Name:ST MARY'S CHIRO MED & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ST MARY'S CHIRO MED & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCCIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-574-5774
Mailing Address - Street 1:3301 W BOYNTON BEACH BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4642
Mailing Address - Country:US
Mailing Address - Phone:561-810-6270
Mailing Address - Fax:
Practice Address - Street 1:3301 W BOYNTON BEACH BLVD STE 12
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4642
Practice Address - Country:US
Practice Address - Phone:561-810-6270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty