=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235097254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER WELLNESS CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2026
-----------------------------------------------------
Last Update Date | 01/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2032 VALLEY SPRINGS CT
-----------------------------------------------------
City | POWHATAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23139-5239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-552-5954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14241 MIDLOTHIAN TPKE STE 233
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23113-6500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-552-5954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/CMO
-----------------------------------------------------
Name | DR. CHRISTOPHER DIETZ
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 804-552-5954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------