| Radiant Wellness Center Llc | |
|
556 1st Ave N St Petersburg FL 33701-3702 | |
| (727) 954-5596 | |
| Not Available |
| Full Name | Radiant Wellness Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 556 1st Ave N, St Petersburg, Florida |
| Authorized Official Name and Position | Ashley Therese Martin (OWNER/DCOTOR) |
| Authorized Official Contact | 8438164274 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiant Wellness Center Llc 700 13th Ave S St Petersburg FL 33701-5310 Ph: (843) 816-4274 | Radiant Wellness Center Llc 556 1st Ave N St Petersburg FL 33701-3702 Ph: (727) 954-5596 |
| NPI Number | 1366064214 |
|---|---|
| Provider Enumeration Date | 05/14/2020 |
| Last Update Date | 05/14/2020 |
| Medicare PECOS PAC ID | 3870915747 |
|---|---|
| Medicare Enrollment ID | O20200623000598 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366064214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Ashley Martin |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1841838620 PECOS PAC ID: 2769804632 Enrollment ID: I20200623000693 |
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