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General NPI Number Information
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NPI Number | 1578170486
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Entity Type | Organization
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Legal Business Name | CONTINUIM WELLNESS, LLC.
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 14785 W 101ST AVE # 101
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City | DYER
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State | IN
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Zip | 46311-3371
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Country | US
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Telephone | 219-689-5563
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Fax | 219-979-5253
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Provider Business Mailing Address
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Address Line | 14785 W 101ST AVE # 101
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City | DYER
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State | IN
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Zip | 46311-3371
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Country | US
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Telephone | 219-689-5563
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Fax | 219-979-5253
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Authorized Official
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Title or Position | MANAGER
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Name | JASON WILSON
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Credential | L,AC.
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Telephone | 219-689-5563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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