Provider Demographics
NPI:1679764906
Name:COMPLETE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:COMPLETE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GATTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-450-8660
Mailing Address - Street 1:845 SOM CENTER ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143
Mailing Address - Country:US
Mailing Address - Phone:440-449-2205
Mailing Address - Fax:440-449-1015
Practice Address - Street 1:845 SOM CENTER ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-449-2205
Practice Address - Fax:440-449-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3271111N00000X
OH4171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty