Healthcare Provider Details

I. General information

NPI: 1295894525
Provider Name (Legal Business Name): WELLNESSONE OF BOARDMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 BOARDMAN CANFIELD RD
BOARDMAN OH
44512
US

IV. Provider business mailing address

11800 E WASHINGTON ST.
BURTON OH
44021
US

V. Phone/Fax

Practice location:
  • Phone: 440-543-2097
  • Fax:
Mailing address:
  • Phone: 440-543-2099
  • Fax: 440-543-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number82002519
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3268
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2435
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3612
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011126
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011128
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT M WHETSTONE
Title or Position: CEO
Credential: D.C.
Phone: 440-543-2097