Provider Demographics
NPI:1235344821
Name:PRECISION WELLNESS AND REHAB CENTER, LLC
Entity Type:Organization
Organization Name:PRECISION WELLNESS AND REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CIOTTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:228-875-0595
Mailing Address - Street 1:PO BOX 1462
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-1462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:228-875-2210
Practice Address - Street 1:5935 WASHINGTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2642
Practice Address - Country:US
Practice Address - Phone:228-875-0595
Practice Address - Fax:228-875-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS123465039AOtherGROUP # FOR BLUE CROSS MS
MS09015198Medicaid
MS5291607OtherGROUP # FOR AET NA
MS5291607OtherGROUP # FOR AET NA