Provider Demographics
NPI:1013106319
Name:WELLNESS CLINIC OF RUTLEDGE
Entity Type:Organization
Organization Name:WELLNESS CLINIC OF RUTLEDGE
Other - Org Name:BACK TO WELLNESS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-557-0211
Mailing Address - Street 1:113 FAIRPLAY ST
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30663-2377
Mailing Address - Country:US
Mailing Address - Phone:706-557-0211
Mailing Address - Fax:706-557-0213
Practice Address - Street 1:113 FAIRPLAY ST
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:GA
Practice Address - Zip Code:30663-2377
Practice Address - Country:US
Practice Address - Phone:706-557-0211
Practice Address - Fax:706-557-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty