Healthcare Provider Details

I. General information

NPI: 1497099634
Provider Name (Legal Business Name): WHOLE BODY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2012
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4483 WEYMOUTH RD
MEDINA OH
44256-8601
US

IV. Provider business mailing address

4483 WEYMOUTH RD
MEDINA OH
44256-8601
US

V. Phone/Fax

Practice location:
  • Phone: 330-764-3434
  • Fax:
Mailing address:
  • Phone: 330-764-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4190
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3529
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4504
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35094835
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP09134
License Number StateOH

VIII. Authorized Official

Name: TIMOTHY WEEKS
Title or Position: OWNER
Credential:
Phone: 330-608-1773