| Green Wave Family Wellness Center | |
|
215 Forest Park Cir Panama City FL 32405-4916 | |
| (850) 215-5657 | |
| (850) 215-5658 |
| Full Name | Green Wave Family Wellness Center |
|---|---|
| Speciality | Chiropractor |
| Location | 215 Forest Park Cir, Panama City, Florida |
| Authorized Official Name and Position | John C Cluxton (MANAGING OFFICER) |
| Authorized Official Contact | 8502155657 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Wave Family Wellness Center 215 Forest Park Cir Panama City FL 32405-4916 Ph: (850) 215-5657 | Green Wave Family Wellness Center 215 Forest Park Cir Panama City FL 32405-4916 Ph: (850) 215-5657 |
| NPI Number | 1568662864 |
|---|---|
| Provider Enumeration Date | 07/24/2007 |
| Last Update Date | 07/24/2007 |
| Medicare PECOS PAC ID | 8325059207 |
|---|---|
| Medicare Enrollment ID | O20060505000867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568662864 | NPI | - | NPPES |
| Provider Name | Tallie Lynn Cluxton |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1477660215 PECOS PAC ID: 4688685563 Enrollment ID: I20060508000217 |
| Provider Name | Kayla Elizabeth Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619502036 PECOS PAC ID: 5294164893 Enrollment ID: I20200402001570 |
| Provider Name | John C Cluxton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1043327794 PECOS PAC ID: 6406867381 Enrollment ID: I20240826000843 |
| Provider Name | Lindsey M Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770232084 PECOS PAC ID: 8224560040 Enrollment ID: I20241018000036 |
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