Healthcare Provider Details

I. General information

NPI: 1598704918
Provider Name (Legal Business Name): WELLNESSONE OF TROY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EDWARDSVILLE RD
TROY IL
62294-1304
US

IV. Provider business mailing address

310 EDWARDSVILLE RD
TROY IL
62294-1304
US

V. Phone/Fax

Practice location:
  • Phone: 618-310-1600
  • Fax:
Mailing address:
  • Phone: 618-310-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name: SCOTT M DORRITY
Title or Position: OWNER
Credential: DC
Phone: 618-236-3600