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General NPI Number Information
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NPI Number | 1063524411
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Entity Type | Organization
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Legal Business Name | WELLNESS DYNAMICS LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 904 N MCQUEEN RD STE 103
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City | GILBERT
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State | AZ
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Zip | 85233-2285
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Country | US
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Telephone | 460-668-1199
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Fax |
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Provider Business Mailing Address
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Address Line | 904 N MCQUEEN RD STE 103
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City | GILBERT
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State | AZ
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Zip | 85233-2285
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Country | US
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Telephone | 460-668-1199
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CASEY MICHAEL JOHNSTON
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Credential | DC
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Telephone | 602-312-4183
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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 | 7458
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License Number State | AZ
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