Provider Demographics
NPI:1518187616
Name:THE CHIROPRACTIC WELLNESS CONNECTION, LLC
Entity Type:Organization
Organization Name:THE CHIROPRACTIC WELLNESS CONNECTION, LLC
Other - Org Name:THE WELLNESS CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAMED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:636-978-0970
Mailing Address - Street 1:111 OFALLON COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7931
Mailing Address - Country:US
Mailing Address - Phone:636-978-0970
Mailing Address - Fax:
Practice Address - Street 1:111 OFALLON COMMONS DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7931
Practice Address - Country:US
Practice Address - Phone:636-978-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MO2006019910111NN1001X
MO2006024312111NP0017X
MO2006024311111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261115407Medicare PIN
MO000015407Medicare PIN