Healthcare Provider Details

I. General information

NPI: 1598164634
Provider Name (Legal Business Name): CENTER OF FUNCTIONAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 N BEND RD
CINCINNATI OH
45224-1340
US

IV. Provider business mailing address

881 N BEND RD
CINCINNATI OH
45224-1340
US

V. Phone/Fax

Practice location:
  • Phone: 937-567-7888
  • Fax: 937-281-0666
Mailing address:
  • Phone: 937-567-7888
  • Fax: 937-281-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BRIAN JOHNSON
Title or Position: OWNER
Credential:
Phone: 937-567-7888