Healthcare Provider Details

I. General information

NPI: 1790007466
Provider Name (Legal Business Name): WELLNESS DIMENSIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 W 110TH ST SUITE 270
OVERLAND PARK KS
66210-2144
US

IV. Provider business mailing address

8717 W 110TH ST SUITE 270
OVERLAND PARK KS
66210-2144
US

V. Phone/Fax

Practice location:
  • Phone: 913-906-7788
  • Fax: 913-766-0436
Mailing address:
  • Phone: 913-906-7788
  • Fax: 913-766-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number0105063
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2100009
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0428042
License Number StateKS

VIII. Authorized Official

Name: DR. COREY MATTHEW PRIEST
Title or Position: PARTNER
Credential: DC
Phone: 913-906-7788