MEDICARE: HEALTH AND WELLNESS CHIROPRACTIC CENTER, 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	111N00000X	Chiropractor	2001011376	MO

General Provider Information

NPI Number	:	1811164312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH AND WELLNESS CHIROPRACTIC CENTER, LLC

Provider Business Mailing Address
First Line	:	3367 S SPRINGFIELD AVE
Second Line	:
City	:	BOLIVAR
State	:	MO
Zip	:	65613-9132
Country	:	US
Telephone Number	:	417-326-2318
Fax Number	:	417-326-2461

Provider Business Practice Location Address
First Line	:	3367 S SPRINGFIELD AVE
Second Line	:
City	:	BOLIVAR
State	:	MO
Zip	:	65613-9132
Country	:	US
Telephone Number	:	417-326-2318
Fax Number	:	417-326-2461

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALMA CHRISTINE POTTER
Credential	:	D.C.
Telephone Number	:	417-326-2318

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/17/2010

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