=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649082611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLNESS ALL WAYS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2025
-----------------------------------------------------
Last Update Date | 01/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15-1505 6TH AVE
-----------------------------------------------------
City | KEAAU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-464-4541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 1 BOX 4063
-----------------------------------------------------
City | KEAAU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96749-9704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | BRETT SANDERS
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 808-464-4541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------