Provider Demographics
NPI:1134191737
Name:KROLICK WELLNESS, LLC
Entity type:Organization
Organization Name:KROLICK WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-703-7730
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-0309
Mailing Address - Country:US
Mailing Address - Phone:864-850-1441
Mailing Address - Fax:864-850-1461
Practice Address - Street 1:630 COFFER LEWIS RD
Practice Address - Street 2:
Practice Address - City:COWPENS
Practice Address - State:SC
Practice Address - Zip Code:29330-9180
Practice Address - Country:US
Practice Address - Phone:864-703-7730
Practice Address - Fax:864-703-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH495Medicaid
SC8361Medicare ID - Type Unspecified