Provider Demographics
NPI:1740257898
Name:HEALING HANDS WELLNESS CENTER
Entity type:Organization
Organization Name:HEALING HANDS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:KIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-762-3888
Mailing Address - Street 1:2636 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5240
Mailing Address - Country:US
Mailing Address - Phone:309-762-3888
Mailing Address - Fax:309-762-6888
Practice Address - Street 1:2636 16TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5240
Practice Address - Country:US
Practice Address - Phone:309-762-3888
Practice Address - Fax:309-762-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211709OtherMEDICARE GROUP #
IL08132084OtherBCBSIL
IL211709Medicare PIN