Provider Demographics
NPI:1326135856
Name:WELLNESS SOLUTIONS INC
Entity Type:Organization
Organization Name:WELLNESS SOLUTIONS INC
Other - Org Name:FAMILY CHIROPRACTIC OF WESTPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:THERIAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-578-9979
Mailing Address - Street 1:PO BOX 1375
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037
Mailing Address - Country:US
Mailing Address - Phone:704-489-2273
Mailing Address - Fax:704-489-2274
Practice Address - Street 1:1895 NORTH HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037
Practice Address - Country:US
Practice Address - Phone:704-489-2273
Practice Address - Fax:704-489-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890833HMedicaid
NC2452313Medicare ID - Type Unspecified
NC890833HMedicaid