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General NPI Number Information
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NPI Number | 1952509929
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Entity Type | Organization
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Legal Business Name | WELLNESS RESOURCES INC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 6625 WAGNER WAY NW #160
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City | GIG HARBOR
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State | WA
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Zip | 98335-8392
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Country | US
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Telephone | 253-851-1560
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Fax | 253-276-0563
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Provider Business Mailing Address
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Address Line | 211 FARRAGUT AVE N #7
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City | PORT ORCHARD
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State | WA
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Zip | 98366-5119
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Country | US
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Telephone | 360-918-3754
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Fax | 253-276-0563
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JOHN ALFRED WALCK
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Credential | MD
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Telephone | 360-535-4729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 35530
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License Number State | WA
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