Provider Demographics
NPI:1982325726
Name:RIVERWELL CHIROPRACTIC PC
Entity Type:Organization
Organization Name:RIVERWELL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-227-2858
Mailing Address - Street 1:113 S PERRY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 S PERRY ST STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4811
Practice Address - Country:US
Practice Address - Phone:678-227-2858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service