Provider Demographics
NPI:1952509929
Name:WELLNESS RESOURCES INC
Entity Type:Organization
Organization Name:WELLNESS RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:WALCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-535-4729
Mailing Address - Street 1:211 FARRAGUT AVE N
Mailing Address - Street 2:#7
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5119
Mailing Address - Country:US
Mailing Address - Phone:360-918-3754
Mailing Address - Fax:253-276-0563
Practice Address - Street 1:6625 WAGNER WAY NW
Practice Address - Street 2:#160
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8392
Practice Address - Country:US
Practice Address - Phone:253-851-1560
Practice Address - Fax:253-276-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA35530261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAO2083Medicare UPIN