10D2107566 CLIA NUMBER - DYNAMIC PAIN & WELLNESS

Laboratory Demographics

  • CLIA Code: 10D2107566
  • Facility Name: DYNAMIC PAIN & WELLNESS
  • Facility Address: 210 SOUTH MAIN STREET
    CRESTVIEW, FL
    ZIP 32536
  • Facility Phone: 850 226-6801
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. TUCKER GREENE
  • NPI Number: 1821540352
  • Taxonomy: 208VP0000X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2107566
LAB Type Physician Office
Facility Name DYNAMIC PAIN & WELLNESS
Street 210 SOUTH MAIN STREET
City CRESTVIEW
State FL
ZIP 32536
Phone 850 226-6801
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 3/25/2024
Certificate Expiration Date 3/24/2026
Facility Type Physician Office
Lab Director DR. TUCKER GREENE

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This page was last updated on: 3/20/2025