=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992571905
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLNESS WORX LIMITED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2023
-----------------------------------------------------
Last Update Date | 11/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1227 RIVERSIDE AVE
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-682-5229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2625 ADOBE DR
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-2439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-682-5229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. JAMES DANIEL DANELLA JR.
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 970-682-5229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------