1013914977 NPI number — HEALTH & WELLNESS CENTER, INC.

Table of content: (NPI 1013914977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013914977 NPI number — HEALTH & WELLNESS CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH & WELLNESS CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPRING LAKE CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013914977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 GLENOLA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28311-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-822-3221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1171 N BRAGG BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28390-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-436-5000
Provider Business Practice Location Address Fax Number:
910-436-7705
Provider Enumeration Date:
07/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DRISCOLL
Authorized Official First Name:
TINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-436-5000

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1830 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89013FC , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89013FC . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com