Provider Demographics
NPI:1376947226
Name:WHOLE BODY NATURAL WELLNESS CENTER
Entity Type:Organization
Organization Name:WHOLE BODY NATURAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:201-310-1911
Mailing Address - Street 1:71 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1307
Practice Address - Country:US
Practice Address - Phone:201-881-9563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000513175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty