Provider Demographics
NPI:1063983583
Name:INTEGRATED WELLNESS LLC
Entity type:Organization
Organization Name:INTEGRATED WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:850-637-5281
Mailing Address - Street 1:4000 BAY POINTE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2916
Mailing Address - Country:US
Mailing Address - Phone:314-779-9740
Mailing Address - Fax:
Practice Address - Street 1:280 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-4841
Practice Address - Country:US
Practice Address - Phone:850-637-5281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty