Healthcare Provider Details

I. General information

NPI: 1013914977
Provider Name (Legal Business Name): HEALTH & WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 N BRAGG BLVD
SPRING LAKE NC
28390-3116
US

IV. Provider business mailing address

508 GLENOLA ST
FAYETTEVILLE NC
28311-3206
US

V. Phone/Fax

Practice location:
  • Phone: 910-436-5000
  • Fax: 910-436-7705
Mailing address:
  • Phone: 910-822-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1830
License Number StateNC

VIII. Authorized Official

Name: DR. TINA MARIE DRISCOLL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 910-436-5000