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General NPI Number Information
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NPI Number | 1821415688
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Entity Type | Organization
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Legal Business Name | COMPLETE WELLNESS CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 03/18/2014
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 95 MIKEL ST NW
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City | CLEVELAND
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State | TN
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Zip | 37312-5332
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Country | US
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Telephone | 423-476-0023
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Fax | 423-476-3353
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Provider Business Mailing Address
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Address Line | PO BOX 6065
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City | CLEVELAND
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State | TN
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Zip | 37320-6065
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Country | US
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Telephone | 423-476-0023
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Fax | 423-476-3353
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC WILLIAM GRUBER
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Credential | DC
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Telephone | 423-476-0023
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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 | DC00000001373
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License Number State | TN
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