Provider Demographics
NPI:1619153186
Name:FAMILY WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:FAMILY WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KINIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:203-225-9977
Mailing Address - Street 1:702 BRIDGEPORT AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4770
Mailing Address - Country:US
Mailing Address - Phone:203-225-9977
Mailing Address - Fax:203-225-9978
Practice Address - Street 1:702 BRIDGEPORT AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4770
Practice Address - Country:US
Practice Address - Phone:203-225-9977
Practice Address - Fax:203-225-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU87674Medicare UPIN