Provider Demographics
NPI:1407885171
Name:WELLNESS @ WORK, PA
Entity Type:Organization
Organization Name:WELLNESS @ WORK, PA
Other - Org Name:CARE CHIROPRACTIC, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-684-4888
Mailing Address - Street 1:837 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3005
Mailing Address - Country:US
Mailing Address - Phone:316-684-4888
Mailing Address - Fax:316-684-1570
Practice Address - Street 1:837 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3005
Practice Address - Country:US
Practice Address - Phone:316-684-4888
Practice Address - Fax:316-684-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04070111N00000X, 111NN1001X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS=========OtherTAX ID