Provider Demographics
NPI:1215411020
Name:STELLHORN WELLNESS, LLC
Entity Type:Organization
Organization Name:STELLHORN WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:YEITER
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:260-432-6508
Mailing Address - Street 1:3464 STELLHORN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4630
Mailing Address - Country:US
Mailing Address - Phone:260-432-6508
Mailing Address - Fax:260-432-6586
Practice Address - Street 1:3464 STELLHORN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4630
Practice Address - Country:US
Practice Address - Phone:260-432-6508
Practice Address - Fax:260-432-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty