Provider Demographics
NPI:1760629513
Name:212 DEGREES OF WELLNESS, LLC
Entity Type:Organization
Organization Name:212 DEGREES OF WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/ CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-323-7214
Mailing Address - Street 1:16753 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16753 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1231
Practice Address - Country:US
Practice Address - Phone:636-273-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009000023111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NT0100XChiropractic ProvidersChiropractorThermographyGroup - Single Specialty