Provider Demographics
NPI:1700113107
Name:WELLSPRING CHIROPRACTIC & ACUPUNCTURE CENTER PA
Entity Type:Organization
Organization Name:WELLSPRING CHIROPRACTIC & ACUPUNCTURE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LUCILE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, L AC
Authorized Official - Phone:828-265-0001
Mailing Address - Street 1:2348 HIGHWAY 105 STE 9
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7802
Mailing Address - Country:US
Mailing Address - Phone:828-265-0001
Mailing Address - Fax:828-265-0117
Practice Address - Street 1:2348 HIGHWAY 105 STE 9
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7802
Practice Address - Country:US
Practice Address - Phone:828-265-0001
Practice Address - Fax:828-265-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1748261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2340599Medicare PIN