Provider Demographics
NPI:1821415688
Name:COMPLETE WELLNESS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:COMPLETE WELLNESS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-476-0023
Mailing Address - Street 1:PO BOX 6065
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-6065
Mailing Address - Country:US
Mailing Address - Phone:423-476-0023
Mailing Address - Fax:423-476-3353
Practice Address - Street 1:95 MIKEL ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5332
Practice Address - Country:US
Practice Address - Phone:423-476-0023
Practice Address - Fax:423-476-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC00000001373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3679665Medicaid
TN3679665Medicaid