Provider Demographics
NPI:1447422340
Name:THE WELLNESS CENTER ON THE NORTHSHORE
Entity Type:Organization
Organization Name:THE WELLNESS CENTER ON THE NORTHSHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-778-7965
Mailing Address - Street 1:1138 S CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-2024
Mailing Address - Country:US
Mailing Address - Phone:985-778-7965
Mailing Address - Fax:
Practice Address - Street 1:1775 LABARRE ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3944
Practice Address - Country:US
Practice Address - Phone:985-778-7965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty