Provider Demographics
NPI:1932415635
Name:PALM BEACH WELLNESS CENTER LLC
Entity type:Organization
Organization Name:PALM BEACH WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DURNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-433-9191
Mailing Address - Street 1:6169 S JOG RD
Mailing Address - Street 2:SUITE B3
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6579
Mailing Address - Country:US
Mailing Address - Phone:561-433-9191
Mailing Address - Fax:561-433-4404
Practice Address - Street 1:6169 S JOG RD
Practice Address - Street 2:SUITE B3
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6579
Practice Address - Country:US
Practice Address - Phone:561-433-9191
Practice Address - Fax:561-433-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8817261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care