Provider Demographics
NPI:1659323665
Name:HEALTHY HABITS WELLNESS CTR, INC
Entity Type:Organization
Organization Name:HEALTHY HABITS WELLNESS CTR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-752-4594
Mailing Address - Street 1:140 STOLLINGS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-4035
Mailing Address - Country:US
Mailing Address - Phone:304-752-4594
Mailing Address - Fax:304-752-5629
Practice Address - Street 1:140 STOLLINGS AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-4011
Practice Address - Country:US
Practice Address - Phone:304-752-4594
Practice Address - Fax:304-752-5629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV785374208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002671Medicaid
WVHE9357541Medicare ID - Type Unspecified