Provider Demographics
NPI:1477852788
Name:CHIROPRACTIC & WELLNESS STUDIO PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC & WELLNESS STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNTER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:KRISTEN
Authorized Official - Last Name:KANNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:802-332-6125
Mailing Address - Street 1:442 WOODSTOCK RD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-9731
Mailing Address - Country:US
Mailing Address - Phone:802-332-6125
Mailing Address - Fax:802-332-8015
Practice Address - Street 1:442 WOODSTOCK RD
Practice Address - Street 2:SUITE 5A
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-9731
Practice Address - Country:US
Practice Address - Phone:802-332-6125
Practice Address - Fax:802-332-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0073893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1215169842OtherNPI