Provider Demographics
NPI:1396400537
Name:ESSENCE OF HEALTH CHIROPRACTIC AND WELLNESS LLC
Entity Type:Organization
Organization Name:ESSENCE OF HEALTH CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANIQUA
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-459-4403
Mailing Address - Street 1:289 BRYSON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5920
Mailing Address - Country:US
Mailing Address - Phone:813-785-7422
Mailing Address - Fax:
Practice Address - Street 1:710 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2623
Practice Address - Country:US
Practice Address - Phone:678-459-4403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty