Provider Demographics
NPI:1033826185
Name:SUPERIOR WELLNESS LLC
Entity Type:Organization
Organization Name:SUPERIOR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIVINCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-343-7173
Mailing Address - Street 1:8170 S HIGHLAND DR STE E4
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6465
Mailing Address - Country:US
Mailing Address - Phone:801-942-4999
Mailing Address - Fax:801-942-8816
Practice Address - Street 1:8170 S HIGHLAND DR STE E4
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6465
Practice Address - Country:US
Practice Address - Phone:801-942-4999
Practice Address - Fax:801-942-8816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty