Flagler Square Wellness Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

CH6297 Issued in FL

Legal business name

FLAGLER SQUARE WELLNESS CENTER

Practice address

1840 Forest Hill Blvd
Suite 201
Lake Clarke Shores, FL 33406-6063

Phone

(305) 698-4000

Fax

(305) 698-4014

NPI assigned

Feb 19, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Gary A Robertson, D.C.

Title

Owner

Phone

(305) 698-4000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1455840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455840000000",
    "number": "1285093179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 FOREST HILL BLVD",
            "address_2": "SUITE 201",
            "city": "LAKE CLARKE SHORES",
            "state": "FL",
            "postal_code": "334066063",
            "telephone_number": "305-698-4000",
            "fax_number": "305-698-4014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 FOREST HILL BLVD",
            "address_2": "SUITE 201",
            "city": "LAKE CLARKE SHORES",
            "state": "FL",
            "postal_code": "334066063",
            "telephone_number": "305-698-4000",
            "fax_number": "305-698-4014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLAGLER SQUARE WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-19",
        "last_updated": "2016-02-19",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-698-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "CH6297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Lake Clarke Shores, FL
• Providers in Lake Clarke Shores, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; 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.