Provider Demographics
NPI:1699006940
Name:SMART HEALTH & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:SMART HEALTH & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-661-8325
Mailing Address - Street 1:409 S PROSPECT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4581
Mailing Address - Country:US
Mailing Address - Phone:309-661-8325
Mailing Address - Fax:
Practice Address - Street 1:409 S PROSPECT RD
Practice Address - Street 2:SUITE D
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4581
Practice Address - Country:US
Practice Address - Phone:309-661-8325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011302111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty