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General NPI Number Information
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NPI Number | 1295406601
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Entity Type | Organization
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Legal Business Name | NATIONAL WELLNESS CENTERS
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Dates
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Enumeration Date | 09/24/2021
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 9700 N 91ST ST STE A115
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5036
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Country | US
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Telephone | 800-553-6102
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 THOMAS CT
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City | MODESTO
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State | CA
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Zip | 95355-7805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY CHRISTEN HOLLOWELL
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Credential |
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Telephone | 209-840-3958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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