Provider Demographics
NPI:1306010319
Name:TRUE WELLNESS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:TRUE WELLNESS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-842-2828
Mailing Address - Street 1:619A S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1421
Mailing Address - Country:US
Mailing Address - Phone:608-842-2828
Mailing Address - Fax:608-842-2826
Practice Address - Street 1:619A S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:DEFOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1421
Practice Address - Country:US
Practice Address - Phone:608-842-2828
Practice Address - Fax:608-842-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4361-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
216738Medicare PIN