Provider Demographics
NPI:1164642724
Name:HEALTH AND WELLNESS CHIROPRACTIC
Entity type:Organization
Organization Name:HEALTH AND WELLNESS CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOMALIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-456-2025
Mailing Address - Street 1:7733 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8609
Mailing Address - Country:US
Mailing Address - Phone:303-456-2025
Mailing Address - Fax:303-456-5225
Practice Address - Street 1:7733 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-8609
Practice Address - Country:US
Practice Address - Phone:303-456-2025
Practice Address - Fax:303-456-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804541Medicare PIN