Provider Demographics
NPI:1578180774
Name:POWELL CHIROPRACTIC & WELLNESS LLC
Entity Type:Organization
Organization Name:POWELL CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-505-8600
Mailing Address - Street 1:47 CLAIREDAN DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8064
Mailing Address - Country:US
Mailing Address - Phone:614-505-8600
Mailing Address - Fax:614-505-6025
Practice Address - Street 1:47 CLAIREDAN DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8064
Practice Address - Country:US
Practice Address - Phone:614-505-8600
Practice Address - Fax:614-505-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty