Healthcare Provider Details

I. General information

NPI: 1255849915
Provider Name (Legal Business Name): EAST WIND WELLNESS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 INDIANAPOLIS BLVD STE 1A
HIGHLAND IN
46322-2664
US

IV. Provider business mailing address

3812 CROSBY DR
VALPARAISO IN
46383-6223
US

V. Phone/Fax

Practice location:
  • Phone: 219-595-5529
  • Fax: 219-513-9273
Mailing address:
  • Phone: 219-242-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number84000190A
License Number StateIN

VIII. Authorized Official

Name: MR. TIMOTHY DAVID SCHLANK
Title or Position: CEO
Credential: LAC
Phone: 219-242-9958