=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669940722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILMINGTON CHIROPRACTIC AND WELLNESS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2018
-----------------------------------------------------
Last Update Date | 08/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 W MAIN ST STE B
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45177-1072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-382-1095
-----------------------------------------------------
Fax | 937-382-3739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 W MAIN ST STE B
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45177-1072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-382-1095
-----------------------------------------------------
Fax | 937-382-3739
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LYNN DELLA LEACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-382-1095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------