Provider Demographics
NPI:1356486187
Name:SANDUSKY WELLNESS CENTER INC
Entity Type:Organization
Organization Name:SANDUSKY WELLNESS CENTER INC
Other - Org Name:SANDUSKY MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WINNESTAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-625-8085
Mailing Address - Street 1:3703 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5719
Mailing Address - Country:US
Mailing Address - Phone:419-625-8085
Mailing Address - Fax:419-625-6004
Practice Address - Street 1:3703 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5719
Practice Address - Country:US
Practice Address - Phone:419-625-8085
Practice Address - Fax:419-625-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2391835Medicaid
OH2391835Medicaid
OH9300081Medicare PIN