Provider Demographics
NPI:1205372968
Name:100 WELLNESS, LLC
Entity Type:Organization
Organization Name:100 WELLNESS, LLC
Other - Org Name:ZONE HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-862-2371
Mailing Address - Street 1:100 S MADISON ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3026
Mailing Address - Country:US
Mailing Address - Phone:303-862-2371
Mailing Address - Fax:
Practice Address - Street 1:100 S MADISON ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3026
Practice Address - Country:US
Practice Address - Phone:303-862-2371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty