Provider Demographics
NPI:1891118121
Name:MERIDIAN WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:MERIDIAN WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:PACWA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-338-2077
Mailing Address - Street 1:1531 HUNT CLUB BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6095
Mailing Address - Country:US
Mailing Address - Phone:615-989-7037
Mailing Address - Fax:615-989-7038
Practice Address - Street 1:1531 HUNT CLUB BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6095
Practice Address - Country:US
Practice Address - Phone:615-989-7037
Practice Address - Fax:615-989-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1841200300OtherINDIVIDUAL NPI