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General NPI Number Information
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NPI Number | 1760503619
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Entity Type | Organization
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Legal Business Name | WELLNESSONE OF COLLINSVILLE
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 410 REGENCY CTR
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City | COLLINSVILLE
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State | IL
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Zip | 62234-4659
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Country | US
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Telephone | 618-343-3602
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Fax |
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Provider Business Mailing Address
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Address Line | 410 REGENCY CTR
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City | COLLINSVILLE
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State | IL
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Zip | 62234-4659
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Country | US
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Telephone | 618-343-3602
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SCOTT M DORRITY
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Credential | D.C.
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Telephone | 618-343-3602
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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 |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | IL
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