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General NPI Number Information
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NPI Number | 1255617106
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Entity Type | Organization
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Legal Business Name | WELLNESS CENTERS OF AMERICA, INC.
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 13057 HIGHWAY 9 N SUITE 230
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City | MILTON
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State | GA
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Zip | 30004-5139
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Country | US
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Telephone | 770-619-5366
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Fax | 770-619-5367
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Provider Business Mailing Address
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Address Line | 6470 E JOHNS XING
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City | DULUTH
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State | GA
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Zip | 30097-2511
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Country | US
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Telephone | 678-802-4958
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Fax | 888-774-0456
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Authorized Official
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Title or Position | CEO
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Name | MR. DAN SIEWERT III
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Credential |
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Telephone | 404-259-8064
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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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