Provider Demographics
NPI:1518426634
Name:WELLSPRING FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WELLSPRING FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-670-6444
Mailing Address - Street 1:429 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1010
Mailing Address - Country:US
Mailing Address - Phone:937-670-2545
Mailing Address - Fax:
Practice Address - Street 1:232 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1100
Practice Address - Country:US
Practice Address - Phone:937-670-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty