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General NPI Number Information
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NPI Number | 1003837170
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Entity Type | Organization
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Legal Business Name | THE WELLNESS WAY GREEN BAY LLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 2525 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-4838
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Country | US
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Telephone | 920-429-2844
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Fax | 920-429-2845
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Provider Business Mailing Address
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Address Line | 2525 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-4838
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Country | US
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Telephone | 920-429-2844
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Fax | 920-429-2845
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK M FLYNN
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Credential | D.C.
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Telephone | 920-429-2844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3623012
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License Number State | WI
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