MEDICARE: MEDICAL WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	2959	OH

General Provider Information

NPI Number	:	1447598123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL WELLNESS, LLC

Provider Business Mailing Address
First Line	:	4760 RED BANK RD
Second Line	:	SUITE 238
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1548
Country	:	US
Telephone Number	:	513-984-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4760 RED BANK RD
Second Line	:	SUITE 238
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1548
Country	:	US
Telephone Number	:	513-984-2700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL BUCHANAN
Credential	:	DC
Telephone Number	:	513-984-2700

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	01/30/2013

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