Provider Demographics
NPI:1457632507
Name:FREMONT HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:FREMONT HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-332-9900
Mailing Address - Street 1:2274 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-1439
Mailing Address - Country:US
Mailing Address - Phone:419-332-9900
Mailing Address - Fax:
Practice Address - Street 1:2274 W STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1439
Practice Address - Country:US
Practice Address - Phone:419-332-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty