Provider Demographics
NPI:1790938330
Name:PURE WELLNESS, LLC
Entity Type:Organization
Organization Name:PURE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-365-6520
Mailing Address - Street 1:550 STANTON CHRISTIANA RD.
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-365-6520
Mailing Address - Fax:302-365-6167
Practice Address - Street 1:550 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 302
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2198
Practice Address - Country:US
Practice Address - Phone:302-365-6520
Practice Address - Fax:302-365-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty