Organization Active NPI

Oceanside Wellness PLLC

  • Chiropractor
  • New Smyrna Beach, FL
National Provider Identifier
1144608969
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH10756 Issued in FL
Legal business name
OCEANSIDE WELLNESS PLLC
Practice address
3516 S Atlantic Avenue
New Smyrna Beach, FL 32169-3628
Phone
(386) 235-4412
Fax
(386) 410-2918
NPI assigned
May 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Phyleischa Owen
Title
Billing Manager
Phone
(407) 312-4613

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CH10756 FL Primary

Addresses

Primary practice location

3516 S Atlantic Avenue
New Smyrna Beach, FL 32169-3628

Mailing address

3516 S Atlantic Avenue
New Smyrna Beach, FL 32169-3628
Phone (386) 235-4412

Other practice location 1

100 Club House Cir Rm 3
New Smyrna Beach, FL 32168-2060
Phone (386) 235-4412

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150814012845 FL Part B Supplier - Clinic/Group Practice 1759696198 Receives reassigned benefits from 3 practitioners
Practice locations: New Smyrna, FL

National Provider Directory

National Provider Directory

Locations

3516 S Atlantic Ave
New Smyrna Beach, FL 32169
Phone (386) 235-4412

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1144608969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3516 S ATLANTIC AVENUE",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321693628",
            "telephone_number": "386-235-4412",
            "fax_number": "863-816-5865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3516 S ATLANTIC AVENUE",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321693628",
            "telephone_number": "386-235-4412",
            "fax_number": "386-410-2918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Club House Cir Rm 3",
            "address_purpose": "LOCATION",
            "city": "New Smyrna Beach",
            "state": "FL",
            "postal_code": "321682060",
            "country_code": "US",
            "telephone_number": "386-235-4412",
            "fax_number": "407-605-0699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OCEANSIDE WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-13",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "OWEN",
        "authorized_official_first_name": "PHYLEISCHA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "407-312-4613"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH10756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Smyrna Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.