MEDICARE: CONNECTICUT AVE HEALTH AND WELLNESS CENTER

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1700248416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTICUT AVE HEALTH AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	5530 WISCONSIN AVE STE 1248
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-4301
Country	:	US
Telephone Number	:	202-966-9280
Fax Number	:	202-966-9380

Provider Business Practice Location Address
First Line	:	5530 WISCONSIN AVE STE 1248
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-4301
Country	:	US
Telephone Number	:	202-966-9280
Fax Number	:	202-966-9380

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	WAYNE P BULLEN
Credential	:	DC
Telephone Number	:	202-966-9280

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/21/2017

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