Provider Demographics
NPI:1811651748
Name:CHAMPION WELLNESS
Entity type:Organization
Organization Name:CHAMPION WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:813-340-4611
Mailing Address - Street 1:3116 TYREE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8421
Mailing Address - Country:US
Mailing Address - Phone:813-340-4611
Mailing Address - Fax:
Practice Address - Street 1:1047 GLENBROOK WAY STE 112
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1309
Practice Address - Country:US
Practice Address - Phone:615-447-3787
Practice Address - Fax:615-827-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty