Provider Demographics
NPI:1457591612
Name:NATURAL WELLNESS CARE CENTER LLC
Entity type:Organization
Organization Name:NATURAL WELLNESS CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARELA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-412-2241
Mailing Address - Street 1:7558 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6080
Mailing Address - Country:US
Mailing Address - Phone:623-412-2241
Mailing Address - Fax:623-412-2251
Practice Address - Street 1:7558 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 4B
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-6080
Practice Address - Country:US
Practice Address - Phone:623-412-2241
Practice Address - Fax:623-412-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1614225100000X
AZ1046111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty