Healthcare Provider Details

I. General information

NPI: 1194996454
Provider Name (Legal Business Name): WELLNESSONE OF WESTFIELD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N COTNER BLVD STE. 201
LINCOLN NE
68505-2339
US

IV. Provider business mailing address

6800 S 32ND ST STE A STE. 201
LINCOLN NE
68516-6036
US

V. Phone/Fax

Practice location:
  • Phone: 402-325-0170
  • Fax: 402-325-0173
Mailing address:
  • Phone: 402-325-0170
  • Fax: 402-325-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1452
License Number StateNE

VIII. Authorized Official

Name: AMANDA RAE HENN
Title or Position: CFO
Credential:
Phone: 402-440-7411