Provider Demographics
NPI:1790007466
Name:WELLNESS DIMENSIONS, LLC
Entity Type:Organization
Organization Name:WELLNESS DIMENSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:PRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-906-7788
Mailing Address - Street 1:8717 W 110TH ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2144
Mailing Address - Country:US
Mailing Address - Phone:913-906-7788
Mailing Address - Fax:913-766-0436
Practice Address - Street 1:8717 W 110TH ST
Practice Address - Street 2:SUITE 270
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2144
Practice Address - Country:US
Practice Address - Phone:913-906-7788
Practice Address - Fax:913-766-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105063111NI0900X
KS2100009175F00000X
KS0428042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1518001098Medicare UPIN
KS1649336249Medicare UPIN
KS1043267404Medicare UPIN