Provider Demographics
NPI:1275068561
Name:WELLNESS MEDICAL LLC
Entity Type:Organization
Organization Name:WELLNESS MEDICAL LLC
Other - Org Name:KENNEDY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:P
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-778-0100
Mailing Address - Street 1:6 SHARPLEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2941
Mailing Address - Country:US
Mailing Address - Phone:302-778-0100
Mailing Address - Fax:
Practice Address - Street 1:6 SHARPLEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2941
Practice Address - Country:US
Practice Address - Phone:302-778-0100
Practice Address - Fax:302-652-1116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000443111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty