Provider Demographics
NPI:1871762104
Name:LOVING CHIROPRACTIC AND WELLNESS CENTER INC
Entity type:Organization
Organization Name:LOVING CHIROPRACTIC AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HAMMOND
Authorized Official - Last Name:LOVING
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT,DC
Authorized Official - Phone:772-219-3313
Mailing Address - Street 1:630 SE MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4410
Mailing Address - Country:US
Mailing Address - Phone:772-219-3313
Mailing Address - Fax:772-219-3314
Practice Address - Street 1:630 SE MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4410
Practice Address - Country:US
Practice Address - Phone:772-219-3313
Practice Address - Fax:772-219-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8004111N00000X
FLPT5764261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88234OtherBLUE CROSS/BLUE SHIELD
FLAJ334Medicare PIN