Provider Demographics
NPI:1760801310
Name:FOUNDATIONS HEALTH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:FOUNDATIONS HEALTH AND WELLNESS CENTER LLC
Other - Org Name:MOUNT ANGEL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PETRACCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-991-5951
Mailing Address - Street 1:209 CROOKED CREEK LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6713
Mailing Address - Country:US
Mailing Address - Phone:503-949-0235
Mailing Address - Fax:503-845-9373
Practice Address - Street 1:393 E MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2575
Practice Address - Country:US
Practice Address - Phone:615-991-5951
Practice Address - Fax:503-845-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty