Provider Demographics
NPI:1457531097
Name:WELLNESS WITHIN CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:WELLNESS WITHIN CHIROPRACTIC, INC
Other - Org Name:WELLNESS WITHIN CHIROPRACTIC AND MASSAGE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STEFAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-640-3207
Mailing Address - Street 1:2263 NE CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5947
Mailing Address - Country:US
Mailing Address - Phone:503-640-3207
Mailing Address - Fax:503-640-5315
Practice Address - Street 1:2263 NE CORNELL RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5947
Practice Address - Country:US
Practice Address - Phone:503-640-3207
Practice Address - Fax:503-640-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273112261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR111276Medicare PIN