Provider Demographics
NPI:1699205690
Name:DORNBIER ENTERPRISE INC
Entity Type:Organization
Organization Name:DORNBIER ENTERPRISE INC
Other - Org Name:WELLSPRING FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:DORNBIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-528-5284
Mailing Address - Street 1:280 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3453
Mailing Address - Country:US
Mailing Address - Phone:931-528-5284
Mailing Address - Fax:
Practice Address - Street 1:280 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3453
Practice Address - Country:US
Practice Address - Phone:931-528-5284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty