Healthcare Provider Details

I. General information

NPI: 1275779266
Provider Name (Legal Business Name): WELLNESSFIRST CHIROPRACTIC OF ODON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S SPRING ST
ODON IN
47562-1314
US

IV. Provider business mailing address

210 N SECTION ST UNIT C
SULLIVAN IN
47882-1237
US

V. Phone/Fax

Practice location:
  • Phone: 812-636-8101
  • Fax:
Mailing address:
  • Phone: 812-268-3400
  • Fax: 812-268-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHELLE CLOTHIER
Title or Position: EXECUTIVE DIRECTOR
Credential: ED
Phone: 812-268-3400