Provider Demographics
NPI:1629604277
Name:360 WELLNESS
Entity Type:Organization
Organization Name:360 WELLNESS
Other - Org Name:360 WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PERSONAL TRAINER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIESENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-530-4397
Mailing Address - Street 1:700 W JEFFERSON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-7603
Mailing Address - Country:US
Mailing Address - Phone:815-530-4397
Mailing Address - Fax:
Practice Address - Street 1:700 W JEFFERSON ST STE 2
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-7603
Practice Address - Country:US
Practice Address - Phone:815-530-4397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE FITNESS TRAINING STUDIO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-16
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty