Provider Demographics
NPI:1629690417
Name:WELLNESS CHIROPRACTIC CENTER, P.S.C.
Entity Type:Organization
Organization Name:WELLNESS CHIROPRACTIC CENTER, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-414-2273
Mailing Address - Street 1:1255 N GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-1495
Mailing Address - Country:US
Mailing Address - Phone:812-414-2273
Mailing Address - Fax:
Practice Address - Street 1:1255 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-1495
Practice Address - Country:US
Practice Address - Phone:812-414-2273
Practice Address - Fax:812-414-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty