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General NPI Number Information
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NPI Number | 1275779266
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Entity Type | Organization
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Legal Business Name | WELLNESSFIRST CHIROPRACTIC OF ODON
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 102 S SPRING ST
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City | ODON
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State | IN
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Zip | 47562-1314
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Country | US
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Telephone | 812-636-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N SECTION ST UNIT C
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City | SULLIVAN
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State | IN
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Zip | 47882-1237
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Country | US
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Telephone | 812-268-3400
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Fax | 812-268-5713
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHELLE CLOTHIER
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Credential | ED
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Telephone | 812-268-3400
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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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