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General NPI Number Information
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NPI Number | 1407192107
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Entity Type | Organization
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Legal Business Name | TOTAL INTEGRATED WELLNESS, INC
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 4600 KIETZKE LN M 249
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City | RENO
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State | NV
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Zip | 89502-5033
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Country | US
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Telephone | 775-825-3625
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 KIETZKE LN M 249
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City | RENO
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State | NV
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Zip | 89502-5033
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Country | US
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Telephone | 775-825-3625
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Fax |
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Authorized Official
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Title or Position | PRESEDENT
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Name | DR. ANDREW WILLIAM JENISON
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Credential | D.C
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Telephone | 775-825-3625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | B01357
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License Number State | NV
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