Provider Demographics
NPI:1063609907
Name:DEAN WELLNESS CENTER LLC
Entity type:Organization
Organization Name:DEAN WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:561-427-6054
Mailing Address - Street 1:3535 MILITARY TRL STE 100
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2779
Mailing Address - Country:US
Mailing Address - Phone:561-427-6054
Mailing Address - Fax:561-427-6019
Practice Address - Street 1:3535 MILITARY TRL STE 100
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2779
Practice Address - Country:US
Practice Address - Phone:561-427-6054
Practice Address - Fax:561-427-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7342Medicare PIN