Provider Demographics
NPI:1629205539
Name:THE CENTER FOR HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:THE CENTER FOR HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-843-7500
Mailing Address - Street 1:12818 TESSON FERRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2945
Mailing Address - Country:US
Mailing Address - Phone:314-843-7500
Mailing Address - Fax:314-843-7503
Practice Address - Street 1:12818 TESSON FERRY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2945
Practice Address - Country:US
Practice Address - Phone:314-843-7500
Practice Address - Fax:314-843-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003502174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty