Provider Demographics
NPI:1396158093
Name:WOLSTEIN CHIROPRACTIC AND SPORTS INJURY CENTER
Entity type:Organization
Organization Name:WOLSTEIN CHIROPRACTIC AND SPORTS INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-787-6677
Mailing Address - Street 1:32976 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3122
Mailing Address - Country:US
Mailing Address - Phone:727-787-6677
Mailing Address - Fax:727-787-1177
Practice Address - Street 1:32976 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3122
Practice Address - Country:US
Practice Address - Phone:727-787-6677
Practice Address - Fax:727-787-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6887111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty