Provider Demographics
NPI:1972371029
Name:WELLNESS ETHOS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WELLNESS ETHOS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-894-8514
Mailing Address - Street 1:3259 E SUNSHINE ST STE DD2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2143
Mailing Address - Country:US
Mailing Address - Phone:417-730-9233
Mailing Address - Fax:
Practice Address - Street 1:3259 E SUNSHINE ST STE DD2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2143
Practice Address - Country:US
Practice Address - Phone:417-730-9233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty