Provider Demographics
NPI:1639490907
Name:WELLNESS WAY CHIROPRACTIC & MASSAGE THERAPY PLLC
Entity Type:Organization
Organization Name:WELLNESS WAY CHIROPRACTIC & MASSAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MINGE
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:423-323-7691
Mailing Address - Street 1:P.O. BOX 607
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-0607
Mailing Address - Country:US
Mailing Address - Phone:423-323-7691
Mailing Address - Fax:423-279-7850
Practice Address - Street 1:1323 HIGHWAY 394
Practice Address - Street 2:SUITE C
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-4133
Practice Address - Country:US
Practice Address - Phone:423-323-7691
Practice Address - Fax:423-279-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G707363Medicare PIN