Provider Demographics
NPI:1255813770
Name:GALESBURG WELLNESS SYSTEMS P.C.
Entity type:Organization
Organization Name:GALESBURG WELLNESS SYSTEMS P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-359-9541
Mailing Address - Street 1:2377 CUMBERLAND SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3251
Mailing Address - Country:US
Mailing Address - Phone:563-359-9541
Mailing Address - Fax:563-344-3914
Practice Address - Street 1:575 N KELLOGG ST STE 2
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-7609
Practice Address - Country:US
Practice Address - Phone:563-344-4778
Practice Address - Fax:563-344-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty