Provider Demographics
NPI:1194077347
Name:PREMIER WELLNESS CENTERS
Entity type:Organization
Organization Name:PREMIER WELLNESS CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-344-1222
Mailing Address - Street 1:7043 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1401
Mailing Address - Country:US
Mailing Address - Phone:772-344-1222
Mailing Address - Fax:772-344-1220
Practice Address - Street 1:7043 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1401
Practice Address - Country:US
Practice Address - Phone:772-344-1222
Practice Address - Fax:772-344-1220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER WELLNESS CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZCH10181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty