Healthcare Provider Details

I. General information

NPI: 1346447901
Provider Name (Legal Business Name): THE WELLNESS CENTER S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N GRAND AVE W
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

203 N GRAND AVE W
SPRINGFIELD IL
62702-2550
US

V. Phone/Fax

Practice location:
  • Phone: 217-522-6500
  • Fax: 217-753-3465
Mailing address:
  • Phone: 217-522-6500
  • Fax: 217-159-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36076506
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. J LAURENCE MILLER
Title or Position: PHYSICIAN
Credential: D.C.
Phone: 217-522-6500