Provider Demographics
NPI:1942484191
Name:WHEELERSBURG WELLNESS CENTER
Entity Type:Organization
Organization Name:WHEELERSBURG WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-574-9392
Mailing Address - Street 1:8508A OHIO RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694
Mailing Address - Country:US
Mailing Address - Phone:740-574-9392
Mailing Address - Fax:740-574-9424
Practice Address - Street 1:8508A OHIO RIVER ROAD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694
Practice Address - Country:US
Practice Address - Phone:740-574-9392
Practice Address - Fax:740-574-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3484111N00000X
OH3495111N00000X
OH34.007823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWH9348281Medicare PIN