Provider Demographics
NPI:1346447901
Name:THE WELLNESS CENTER S.C.
Entity Type:Organization
Organization Name:THE WELLNESS CENTER S.C.
Other - Org Name:BAYTREE MEDICAL SC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:LAURENCE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-522-6500
Mailing Address - Street 1:203 N GRAND AVE W
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-2550
Mailing Address - Country:US
Mailing Address - Phone:217-522-6500
Mailing Address - Fax:217-159-3465
Practice Address - Street 1:203 N GRAND AVE W
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702
Practice Address - Country:US
Practice Address - Phone:217-522-6500
Practice Address - Fax:217-753-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36076506207Q00000X
IL111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1478530OtherCOVENTRY
IL08482049OtherBLUE CROSS BLUE SHIELD OF
IL194224OtherHEALTHLINK
IL1478530OtherCOVENTRY
IL369490Medicare ID - Type Unspecified