Healthcare Provider Details

I. General information

NPI: 1568870038
Provider Name (Legal Business Name): NATURAL HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 AIRWAY DR STE B
BOWLING GREEN KY
42103-7125
US

IV. Provider business mailing address

2424 AIRWAY DR STE B
BOWLING GREEN KY
42103-7125
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-6781
  • Fax: 270-746-0204
Mailing address:
  • Phone: 270-843-6781
  • Fax: 270-746-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4859
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number1093908
License Number StateKY

VIII. Authorized Official

Name: JODIE A HAWLEY
Title or Position: MEMBER
Credential:
Phone: 270-843-6781