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General NPI Number Information
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NPI Number | 1225356066
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Entity Type | Organization
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Legal Business Name | COMMUNITY WELLNESS CENTER
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 484 MAINE AVE STE 2D
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City | FARMINGDALE
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State | ME
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Zip | 04344-2903
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Country | US
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Telephone | 207-582-2323
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Fax | 207-588-0294
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Provider Business Mailing Address
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Address Line | 484 MAINE AVE STE 2D
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City | FARMINGDALE
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State | ME
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Zip | 04344-2903
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Country | US
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Telephone | 207-582-2323
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Fax | 207-588-0294
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | LIA O ANGELINI
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Credential | MT
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Telephone | 207-582-2323
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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 | CR1753
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CR1840
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License Number State | ME
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