Provider Demographics
NPI:1811231178
Name:WELLNESS DOCTOR, INC.
Entity Type:Organization
Organization Name:WELLNESS DOCTOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:KREMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-318-1000
Mailing Address - Street 1:1345 NW WALL ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1967
Mailing Address - Country:US
Mailing Address - Phone:541-318-1000
Mailing Address - Fax:541-318-7050
Practice Address - Street 1:1345 NW WALL ST STE 202
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1967
Practice Address - Country:US
Practice Address - Phone:541-318-1000
Practice Address - Fax:541-318-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3681261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center