Healthcare Provider Details

I. General information

NPI: 1407885171
Provider Name (Legal Business Name): WELLNESS @ WORK, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 S HILLSIDE ST
WICHITA KS
67211-3005
US

IV. Provider business mailing address

837 S HILLSIDE ST
WICHITA KS
67211-3005
US

V. Phone/Fax

Practice location:
  • Phone: 316-684-4888
  • Fax: 316-684-1570
Mailing address:
  • Phone: 316-684-4888
  • Fax: 316-684-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number01-04070
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number01-04070
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-04070
License Number StateKS

VIII. Authorized Official

Name: JEFFREY D HENNES
Title or Position: OWNER
Credential: DC
Phone: 316-684-4888