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General NPI Number Information
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NPI Number | 1861743148
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Entity Type | Organization
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Legal Business Name | ROUTE 2 WELLNESS, P.C.
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 2072B E COMMERCIAL AVE
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City | LOWELL
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State | IN
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Zip | 46356-2116
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Country | US
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Telephone | 219-696-8916
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Fax | 219-696-6880
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Provider Business Mailing Address
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Address Line | 2072B E COMMERCIAL AVE
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City | LOWELL
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State | IN
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Zip | 46356-2116
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Country | US
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Telephone | 219-696-8916
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Fax | 219-696-6880
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CASEY H WALKER
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Credential | D.C.
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Telephone | 219-696-9816
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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 | 0800252A
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License Number State | IN
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