Provider Demographics
NPI:1720148265
Name:WELLNESS EXPERIENCE INC
Entity Type:Organization
Organization Name:WELLNESS EXPERIENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:LAURICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:561-441-4221
Mailing Address - Street 1:9825 SW 18TH ST
Mailing Address - Street 2:SUITE 200-300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-6628
Mailing Address - Country:US
Mailing Address - Phone:561-883-0090
Mailing Address - Fax:561-883-0676
Practice Address - Street 1:9825 SW 18TH ST
Practice Address - Street 2:SUITE 200-300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-6628
Practice Address - Country:US
Practice Address - Phone:561-883-0090
Practice Address - Fax:561-883-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70234ZMedicare ID - Type Unspecified