Provider Demographics
NPI:1386028306
Name:MIDWEST WELLNESS
Entity Type:Organization
Organization Name:MIDWEST WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:NICODEMUS
Authorized Official - Last Name:HINDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-895-5772
Mailing Address - Street 1:PO BOX 981
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:IA
Mailing Address - Zip Code:50170-0981
Mailing Address - Country:US
Mailing Address - Phone:641-259-3044
Mailing Address - Fax:
Practice Address - Street 1:206 E MARION ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:IA
Practice Address - Zip Code:50170-7763
Practice Address - Country:US
Practice Address - Phone:641-259-3044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty