Provider Demographics
NPI:1811313588
Name:TOTAL WELLNESS SPORTS AND CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:TOTAL WELLNESS SPORTS AND CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANNE CHESTER
Authorized Official - Last Name:HANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-657-5062
Mailing Address - Street 1:1814 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6641
Mailing Address - Country:US
Mailing Address - Phone:561-582-2225
Mailing Address - Fax:
Practice Address - Street 1:291 S COLLIER BLVD UNIT 109
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-4830
Practice Address - Country:US
Practice Address - Phone:239-394-7221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty