Provider Demographics
NPI:1619706124
Name:WELLNESS WAY ESTES PARK LLC
Entity type:Organization
Organization Name:WELLNESS WAY ESTES PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-745-3166
Mailing Address - Street 1:521 S SAINT VRAIN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-0018
Mailing Address - Country:US
Mailing Address - Phone:970-577-0007
Mailing Address - Fax:
Practice Address - Street 1:521 S SAINT VRAIN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-0018
Practice Address - Country:US
Practice Address - Phone:970-577-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty