Provider Demographics
NPI:1255652228
Name:ZEN WELLNESS
Entity Type:Organization
Organization Name:ZEN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRIMOS
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:219-980-2502
Mailing Address - Street 1:6111 HARRISON ST STE 304
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2972
Mailing Address - Country:US
Mailing Address - Phone:219-980-2502
Mailing Address - Fax:219-886-0245
Practice Address - Street 1:6111 HARRISON ST STE 304
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2972
Practice Address - Country:US
Practice Address - Phone:219-980-2502
Practice Address - Fax:219-886-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty