Provider Demographics
NPI:1144003336
Name:E CLAIRE WELLNESS
Entity type:Organization
Organization Name:E CLAIRE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:618-203-4624
Mailing Address - Street 1:212 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2925
Mailing Address - Country:US
Mailing Address - Phone:618-319-0672
Mailing Address - Fax:
Practice Address - Street 1:212 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2925
Practice Address - Country:US
Practice Address - Phone:618-713-1249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty