Provider Demographics
NPI:1508537606
Name:WELLNESS FROM THE ROOTS, PLLC
Entity Type:Organization
Organization Name:WELLNESS FROM THE ROOTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEEGAN
Authorized Official - Middle Name:JAE
Authorized Official - Last Name:ZIEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-630-2721
Mailing Address - Street 1:1230 VERANDA WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8323
Mailing Address - Country:US
Mailing Address - Phone:757-630-2721
Mailing Address - Fax:
Practice Address - Street 1:1230 VERANDA WAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8323
Practice Address - Country:US
Practice Address - Phone:757-630-2721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty