Provider Demographics
NPI:1578926424
Name:CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAREK
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:OLEARCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-993-4899
Mailing Address - Street 1:75 HAZARD AVE UNIT I
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3887
Mailing Address - Country:US
Mailing Address - Phone:860-993-4899
Mailing Address - Fax:860-741-6818
Practice Address - Street 1:75 HAZARD AVE UNIT I
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3887
Practice Address - Country:US
Practice Address - Phone:860-993-4899
Practice Address - Fax:860-741-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001691261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001524Medicare UPIN