MEDICARE: INNER PEACE WELLNESS CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
2	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1881410413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER PEACE WELLNESS CENTER INC.

Provider Business Mailing Address
First Line	:	4300 ROGERS AVE
Second Line	:	STE 20 PMB 233
City	:	FORT SMITH
State	:	AR
Zip	:	72903
Country	:	US
Telephone Number	:	479-529-0985
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 ROGERS AVE STE B
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5281
Country	:	US
Telephone Number	:	479-529-0985
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NORA E MARIN
Credential	:
Telephone Number	:	479-529-0985

Provider Enumeration Date	:	11/27/2024
Last Update Date	:	11/27/2024

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