Provider Demographics
NPI:1679969422
Name:HEALTH AND WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:HEALTH AND WELLNESS CLINIC, LLC
Other - Org Name:THE HEALTH AND WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:CHIPP-NATHANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-254-2397
Mailing Address - Street 1:PO BOX 4444
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-0444
Mailing Address - Country:US
Mailing Address - Phone:913-579-1154
Mailing Address - Fax:
Practice Address - Street 1:7423 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-1975
Practice Address - Country:US
Practice Address - Phone:913-579-1154
Practice Address - Fax:913-273-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty