Provider Demographics
NPI:1467960534
Name:A WAY OF WELLNESS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:A WAY OF WELLNESS CHIROPRACTIC, LLC
Other - Org Name:A WAY OF WELLNESS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-336-2225
Mailing Address - Street 1:1121 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2160
Mailing Address - Country:US
Mailing Address - Phone:812-336-2225
Mailing Address - Fax:812-822-0606
Practice Address - Street 1:1121 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2160
Practice Address - Country:US
Practice Address - Phone:812-336-2225
Practice Address - Fax:812-822-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty