Provider Demographics
NPI:1225119852
Name:CHIROPRACTIC WELLNESS CENTER, LTD.
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-754-1234
Mailing Address - Street 1:4505 WOODGATE DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-8203
Mailing Address - Country:US
Mailing Address - Phone:608-754-1234
Mailing Address - Fax:608-754-9494
Practice Address - Street 1:4505 WOODGATE DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-8203
Practice Address - Country:US
Practice Address - Phone:608-754-1234
Practice Address - Fax:608-754-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty