Provider Demographics
NPI:1881418911
Name:OCEAN PARK WELLNESS LLC
Entity type:Organization
Organization Name:OCEAN PARK WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND, AP
Authorized Official - Phone:386-847-9797
Mailing Address - Street 1:5656 ISABELLE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-6255
Mailing Address - Country:US
Mailing Address - Phone:386-847-9797
Mailing Address - Fax:
Practice Address - Street 1:5656 ISABELLE AVE STE 6
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-6255
Practice Address - Country:US
Practice Address - Phone:386-847-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty