Provider Demographics
NPI:1518002476
Name:WELLNESSFIRSTCHIROPRACTIC INC.
Entity Type:Organization
Organization Name:WELLNESSFIRSTCHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-268-3400
Mailing Address - Street 1:222 W BEECH ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-1462
Mailing Address - Country:US
Mailing Address - Phone:812-268-3400
Mailing Address - Fax:
Practice Address - Street 1:222 W BEECH ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-1462
Practice Address - Country:US
Practice Address - Phone:812-268-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200852610AMedicaid
IN200852610AMedicaid