Provider Demographics
NPI:1659827962
Name:FUSION CHIROPRACTIC HEALTH & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:FUSION CHIROPRACTIC HEALTH & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:KALIA
Authorized Official - Last Name:ANCRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-355-1600
Mailing Address - Street 1:680 E MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4803
Mailing Address - Country:US
Mailing Address - Phone:863-537-7330
Mailing Address - Fax:863-582-9341
Practice Address - Street 1:680 E MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4803
Practice Address - Country:US
Practice Address - Phone:863-537-7330
Practice Address - Fax:863-582-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty