Provider Demographics
NPI:1629260831
Name:SELF HEALTH AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:SELF HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS. OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SELF
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC, CERT A/P
Authorized Official - Phone:865-687-7600
Mailing Address - Street 1:115 GRESHAM RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-3209
Mailing Address - Country:US
Mailing Address - Phone:865-687-7600
Mailing Address - Fax:
Practice Address - Street 1:115 GRESHAM RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-3209
Practice Address - Country:US
Practice Address - Phone:865-687-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty