Provider Demographics
NPI:1164759254
Name:WELLNESS ONE LLC
Entity Type:Organization
Organization Name:WELLNESS ONE LLC
Other - Org Name:BACK ON TRACK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:251-625-2215
Mailing Address - Street 1:9912 DIMITRIOS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9564
Mailing Address - Country:US
Mailing Address - Phone:251-625-2215
Mailing Address - Fax:
Practice Address - Street 1:9912 DIMITRIOS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9564
Practice Address - Country:US
Practice Address - Phone:251-625-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty