Provider Demographics
NPI:1275779266
Name:WELLNESSFIRST CHIROPRACTIC OF ODON
Entity Type:Organization
Organization Name:WELLNESSFIRST CHIROPRACTIC OF ODON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:ED
Authorized Official - Phone:812-268-3400
Mailing Address - Street 1:210 N SECTION ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-1237
Mailing Address - Country:US
Mailing Address - Phone:812-268-3400
Mailing Address - Fax:812-268-5713
Practice Address - Street 1:102 S SPRING ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562-1314
Practice Address - Country:US
Practice Address - Phone:812-636-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty