Provider Demographics
NPI:1841569761
Name:WELLNESS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:WELLNESS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-636-6186
Mailing Address - Street 1:543 THIRD STREET
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5052
Mailing Address - Country:US
Mailing Address - Phone:503-636-6186
Mailing Address - Fax:503-636-6186
Practice Address - Street 1:543 THIRD STREET
Practice Address - Street 2:SUITE A-3
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-5052
Practice Address - Country:US
Practice Address - Phone:503-636-6186
Practice Address - Fax:503-636-6186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROR0000GQCTRMedicare UPIN