Provider Demographics
NPI:1255849915
Name:EAST WIND WELLNESS INCORPORATED
Entity Type:Organization
Organization Name:EAST WIND WELLNESS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHLANK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:219-242-9958
Mailing Address - Street 1:3812 CROSBY DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6223
Mailing Address - Country:US
Mailing Address - Phone:219-242-9958
Mailing Address - Fax:
Practice Address - Street 1:9501 INDIANAPOLIS BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2664
Practice Address - Country:US
Practice Address - Phone:219-595-5529
Practice Address - Fax:219-513-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000190A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty