Provider Demographics
NPI:1578163283
Name:WELLNESS INC
Entity Type:Organization
Organization Name:WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TIBBITTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-394-3991
Mailing Address - Street 1:16372 162ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2847
Mailing Address - Country:US
Mailing Address - Phone:425-394-3991
Mailing Address - Fax:
Practice Address - Street 1:7149 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8620
Practice Address - Country:US
Practice Address - Phone:425-394-3991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty