Provider Demographics
NPI:1811109564
Name:ESSENTIAL WELLNESS, LLC
Entity type:Organization
Organization Name:ESSENTIAL WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:JOAQUIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:919-829-2111
Mailing Address - Street 1:418 SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1734
Mailing Address - Country:US
Mailing Address - Phone:919-829-2111
Mailing Address - Fax:919-829-2111
Practice Address - Street 1:418 SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1734
Practice Address - Country:US
Practice Address - Phone:919-829-2111
Practice Address - Fax:919-829-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374171100000X
NC378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty