Provider Demographics
NPI:1720476419
Name:NATURAL WELLNESS LLC
Entity Type:Organization
Organization Name:NATURAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE/REGISTERED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RACKOUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-822-8039
Mailing Address - Street 1:2635 45TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2902
Mailing Address - Country:US
Mailing Address - Phone:219-595-3393
Mailing Address - Fax:219-595-3396
Practice Address - Street 1:2635 45TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2902
Practice Address - Country:US
Practice Address - Phone:219-595-3393
Practice Address - Fax:219-595-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002683A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty