Basic Information
| Provider Information | |||||||||
| NPI: | 1861039109 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACORN WELLNESS CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2506 ACORN ST | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349474750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724484748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2506 ACORN ST | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349474750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724484748 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2019 | ||||||||
| LastUpdateDate: | 12/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | GREENBERG | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CHIROPRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 9547163664 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.