Healthcare Provider Details

I. General information

NPI: 1023628476
Provider Name (Legal Business Name): THE WELLNESS WAY NORTH PHOENIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34406 N 27TH DR STE 139
PHOENIX AZ
85085-7733
US

IV. Provider business mailing address

34406 N 27TH DR STE 139
PHOENIX AZ
85085-7733
US

V. Phone/Fax

Practice location:
  • Phone: 623-440-8491
  • Fax:
Mailing address:
  • Phone: 623-440-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: PATRICK FLYNN
Title or Position: OWNER
Credential: DC
Phone: 920-429-2844