Provider Demographics
NPI:1669940722
Name:WILMINGTON CHIROPRACTIC AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:WILMINGTON CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:DELLA
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-382-1095
Mailing Address - Street 1:1600 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-1072
Mailing Address - Country:US
Mailing Address - Phone:937-382-1095
Mailing Address - Fax:937-382-3739
Practice Address - Street 1:1600 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-1072
Practice Address - Country:US
Practice Address - Phone:937-382-1095
Practice Address - Fax:937-382-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty