Provider Demographics
NPI:1972067361
Name:GREAT RIVER FAMILY WELLNESS
Entity Type:Organization
Organization Name:GREAT RIVER FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARGUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-764-3613
Mailing Address - Street 1:1909 52ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:563-210-4803
Mailing Address - Fax:
Practice Address - Street 1:1909 52ND AVENUE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6126
Practice Address - Country:US
Practice Address - Phone:563-210-4803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT RIVER FAMILY WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty