Provider Demographics
NPI:1225202088
Name:HEALTH AND WELLNESS CHIROPRACTIC
Entity Type:Organization
Organization Name:HEALTH AND WELLNESS CHIROPRACTIC
Other - Org Name:HEALTH AND WELLNESS CHIROPRACTIC CENTER, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:TOMALIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-887-0624
Mailing Address - Street 1:13606 XAVIER LN
Mailing Address - Street 2:UNIT D
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-3604
Mailing Address - Country:US
Mailing Address - Phone:720-887-0624
Mailing Address - Fax:720-887-0632
Practice Address - Street 1:6565 W JEWELL AVE
Practice Address - Street 2:SUITE 12A
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7187
Practice Address - Country:US
Practice Address - Phone:720-887-0624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804541Medicare PIN