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General NPI Number Information
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NPI Number | 1043785587
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MOMMA WELLNESS INC
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 6250 GRAND CENTRAL AVE
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City | PARKERSBURG
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State | WV
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Zip | 26105-8924
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Country | US
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Telephone | 304-481-4751
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Fax |
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Provider Business Mailing Address
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Address Line | 6250 GRAND CENTRAL AVE
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City | PARKERSBURG
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State | WV
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Zip | 26105-8924
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Country | US
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Telephone | 304-481-4751
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEAN K HESSON
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Credential | DC
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Telephone | 304-481-4751
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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 |
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License Number State |
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