Provider Demographics
NPI:1902548787
Name:PK HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:PK HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHENG
Authorized Official - Middle Name:BUN
Authorized Official - Last Name:KOUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-654-3500
Mailing Address - Street 1:6 UNION ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4784
Mailing Address - Country:US
Mailing Address - Phone:617-257-5180
Mailing Address - Fax:
Practice Address - Street 1:6 UNION ST STE 1B
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4784
Practice Address - Country:US
Practice Address - Phone:617-257-5180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty