Provider Demographics
NPI:1831385277
Name:CENTER FOR INTEGRATIVE WELLNESS LLC
Entity type:Organization
Organization Name:CENTER FOR INTEGRATIVE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-665-0400
Mailing Address - Street 1:8529 N DIXIE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2400
Mailing Address - Country:US
Mailing Address - Phone:937-665-0440
Mailing Address - Fax:937-665-0465
Practice Address - Street 1:8529 N DIXIE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2400
Practice Address - Country:US
Practice Address - Phone:937-665-0440
Practice Address - Fax:937-665-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherEIN
OHV09113Medicare UPIN
OH9361231Medicare PIN