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General NPI Number Information
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NPI Number | 1568898112
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Entity Type | Organization
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Legal Business Name | WELLNESS VENTURES
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Dates
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Enumeration Date | 09/15/2013
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Last Update Date | 09/15/2013
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Provider Practice Location Address
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Address Line | 5130 N 19TH AVE STE 3
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City | PHOENIX
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State | AZ
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Zip | 85015-3222
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Country | US
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Telephone | 480-440-3289
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Fax |
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Provider Business Mailing Address
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Address Line | 714 E HAMPTON CT
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City | GILBERT
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State | AZ
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Zip | 85295-5917
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Country | US
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Telephone | 480-440-3289
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY ROGERS
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Credential | D.C.
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Telephone | 480-440-3289
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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 | 7980
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License Number State | AZ
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