Provider Demographics
NPI:1932871027
Name:INTENTIONAL WELLNESS LLC
Entity Type:Organization
Organization Name:INTENTIONAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:URRECHAGA QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-377-9554
Mailing Address - Street 1:105 GREENLAND DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5354
Mailing Address - Country:US
Mailing Address - Phone:843-797-3290
Mailing Address - Fax:
Practice Address - Street 1:105 GREENLAND DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5354
Practice Address - Country:US
Practice Address - Phone:843-797-3290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty