Provider Demographics
NPI:1215387428
Name:ROCK CITY WELLNESS, LLC
Entity type:Organization
Organization Name:ROCK CITY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYGUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-215-2243
Mailing Address - Street 1:5302 YACHT HAVEN GRANDE
Mailing Address - Street 2:UNIT 49
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-5004
Mailing Address - Country:US
Mailing Address - Phone:340-998-7357
Mailing Address - Fax:
Practice Address - Street 1:5302 YACHT HAVEN GRANDE
Practice Address - Street 2:SUITE 100
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-5004
Practice Address - Country:US
Practice Address - Phone:340-998-7357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI68111N00000X
VI72111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1598171571OtherINDIVIDUAL NPI
VI1801243647OtherINDIVIDUAL NPI
VI1598171571OtherINDIVIDUAL NPI