Provider Demographics
NPI:1821230632
Name:TOMPKINS WELLNESS CENTER INC
Entity Type:Organization
Organization Name:TOMPKINS WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:MERRILL
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-336-2620
Mailing Address - Street 1:180 MALL RD
Mailing Address - Street 2:STE H
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-9602
Mailing Address - Country:US
Mailing Address - Phone:417-336-2620
Mailing Address - Fax:417-336-2655
Practice Address - Street 1:180 MALL RD
Practice Address - Street 2:STE H
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-9602
Practice Address - Country:US
Practice Address - Phone:417-336-2620
Practice Address - Fax:417-336-2655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1638Medicaid
MOMA1638Medicaid
MOMA1638Medicare PIN
MOMA1638Medicare Oscar/Certification