Provider Demographics
NPI:1538583752
Name:CANTON WELLNESS CENTER LLC
Entity type:Organization
Organization Name:CANTON WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEINERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-720-4090
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30169-1057
Mailing Address - Country:US
Mailing Address - Phone:770-310-2086
Mailing Address - Fax:770-992-3676
Practice Address - Street 1:1558 MARIETTA HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3616
Practice Address - Country:US
Practice Address - Phone:770-310-2086
Practice Address - Fax:770-992-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty