Provider Demographics
NPI:1104222025
Name:PERRY LAKE WELLNESS SOLUTION CENTERS, LLC
Entity Type:Organization
Organization Name:PERRY LAKE WELLNESS SOLUTION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:FILBERTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-597-2400
Mailing Address - Street 1:603 CEDAR ST
Mailing Address - Street 2:PO BOX 3
Mailing Address - City:PERRY
Mailing Address - State:KS
Mailing Address - Zip Code:66073-4357
Mailing Address - Country:US
Mailing Address - Phone:785-597-2400
Mailing Address - Fax:
Practice Address - Street 1:603 CEDAR ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:KS
Practice Address - Zip Code:66073-4357
Practice Address - Country:US
Practice Address - Phone:785-597-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05339111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty