Healthcare Provider Details

I. General information

NPI: 1992126007
Provider Name (Legal Business Name): HOMETOWN WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 MAIN ST
HEBRON ND
58638-7056
US

IV. Provider business mailing address

PO BOX 31
HEBRON ND
58638-0031
US

V. Phone/Fax

Practice location:
  • Phone: 701-878-4300
  • Fax: 701-878-4300
Mailing address:
  • Phone: 701-878-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number826
License Number StateND

VIII. Authorized Official

Name: DR. SANDEE JOY COLEMAN
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 701-878-4300