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General NPI Number Information
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NPI Number | 1447596317
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Entity Type | Organization
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Legal Business Name | WELLNESS CENTER OF INDIANA LLC
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Dates
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Enumeration Date | 12/21/2012
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 1706 MEDICAL ARTS DR SUITE 6
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City | HUNTINGBURG
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State | IN
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Zip | 47542-9049
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Country | US
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Telephone | 812-683-2215
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Fax | 812-683-2064
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Provider Business Mailing Address
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Address Line | 1706 MEDICAL ARTS DR SUITE 6
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City | HUNTINGBURG
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State | IN
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Zip | 47542-9049
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Country | US
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Telephone | 812-683-2215
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Fax | 812-683-2064
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILLIP G GILBERT
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Credential | D.C.
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Telephone | 812-683-2215
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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 | 08000658A
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License Number State | IN
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