Provider Demographics
NPI:1942596184
Name:WELLNESS HEALTH CARE LLC
Entity Type:Organization
Organization Name:WELLNESS HEALTH CARE LLC
Other - Org Name:WHC LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR OF RECORD
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-822-0900
Mailing Address - Street 1:1377 DORCHESTER AVE
Mailing Address - Street 2:2FL
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2950
Mailing Address - Country:US
Mailing Address - Phone:617-822-0900
Mailing Address - Fax:617-822-0800
Practice Address - Street 1:1377 DORCHESTER AVE
Practice Address - Street 2:2FL
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2950
Practice Address - Country:US
Practice Address - Phone:617-822-0900
Practice Address - Fax:617-822-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service