Healthcare Provider Details

I. General information

NPI: 1841536430
Provider Name (Legal Business Name): MOVEWELL SPINE & SPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 HURRICANE LN STE 102
WILLISTON VT
05495-2080
US

IV. Provider business mailing address

372 HURRICANE LN STE 102
WILLISTON VT
05495-2080
US

V. Phone/Fax

Practice location:
  • Phone: 802-497-1002
  • Fax:
Mailing address:
  • Phone: 802-802-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006.0056369
License Number StateVT

VIII. Authorized Official

Name: JASON WOLSTENHOLME
Title or Position: PRESIDENT
Credential: DC
Phone: 802-497-1002