NPIMap

Organization Active NPI

Central Florida Integrated Wellness Clinic PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Maitland, FL
National Provider Identifier
1265727861
Registry record updated Jun 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
ME45785 Issued in FL
Legal business name
CENTRAL FLORIDA INTEGRATED WELLNESS CLINIC PLLC
Practice address
500 E Horatio Ave
Suite 5
Maitland, FL 32751-7310
Phone
(407) 629-5333
Fax
(407) 629-5343
NPI assigned
Jun 13, 2011
Last updated
Jun 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2011

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

Authorized official

Name
Dr. Channing C. Bolick, D.C.NPI 1316936206
Title
MGR
Phone
(407) 629-5333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH7882 FL
Pain Medicine (Anesthesiology) Physician 207LP2900X ME45785 FL Primary

Addresses

Primary practice location

500 E Horatio Ave
Suite 5
Maitland, FL 32751-7310

Mailing address

500 E Horatio Ave
Suite 5
Maitland, FL 32751-7310
Phone (407) 629-5333

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1307923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307923200000",
    "number": "1265727861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E HORATIO AVE",
            "address_2": "SUITE 5",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517310",
            "telephone_number": "407-629-5333",
            "fax_number": "407-629-5343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E HORATIO AVE",
            "address_2": "SUITE 5",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517310",
            "telephone_number": "407-629-5333",
            "fax_number": "407-629-5343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL FLORIDA INTEGRATED WELLNESS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-13",
        "last_updated": "2011-06-13",
        "status": "A",
        "authorized_official_last_name": "BOLICK",
        "authorized_official_first_name": "CHANNING",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "407-629-5333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH7882",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "ME45785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.