Provider Demographics
NPI:1194143263
Name:FAMILY TREE WELLNESS INSTITUTE, LLC.
Entity type:Organization
Organization Name:FAMILY TREE WELLNESS INSTITUTE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-443-4203
Mailing Address - Street 1:13093 W CEDAR DR
Mailing Address - Street 2:APT. 223
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1923
Mailing Address - Country:US
Mailing Address - Phone:850-443-4203
Mailing Address - Fax:
Practice Address - Street 1:3333 S BANNOCK ST
Practice Address - Street 2:SUITE 235
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2432
Practice Address - Country:US
Practice Address - Phone:850-443-4203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR0007058305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service