Basic Information
Provider Information
NPI: 1972633154
EntityType: 2
ReplacementNPI:  
OrganizationName: WELLNESS ASSOCIATES, PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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Mailing Information
Address1: 1839 S ALMA SCHOOL RD
Address2: SUITE 354
City: MESA
State: AZ
PostalCode: 852103023
CountryCode: US
TelephoneNumber: 4807262287
FaxNumber:  
Practice Location
Address1: 1839 S ALMA SCHOOL RD
Address2: SUITE 354
City: MESA
State: AZ
PostalCode: 852103023
CountryCode: US
TelephoneNumber: 4807262287
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/06/2007
LastUpdateDate: 11/30/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BOCK
AuthorizedOfficialFirstName: JOSH
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 4807262287
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: D.C.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X AZY193400000X SINGLE SPECIALTY GROUPChiropractic ProvidersChiropractor 

No ID Information.


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