Basic Information
| Provider Information | |||||||||
| NPI: | 1164944898 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVERWELL INTEGRATED MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060405251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605330179 | ||||||||
| FaxNumber: | 8666034163 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060405251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605330179 | ||||||||
| FaxNumber: | 8666034163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZACHAU | ||||||||
| AuthorizedOfficialFirstName: | KATELYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8605330179 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.