Provider Demographics
NPI:1285053231
Name:HOLISTIC WELLNESS, INC
Entity type:Organization
Organization Name:HOLISTIC WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-613-0597
Mailing Address - Street 1:1260 S HOVER ST
Mailing Address - Street 2:STE D
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7911
Mailing Address - Country:US
Mailing Address - Phone:303-652-0900
Mailing Address - Fax:720-907-0362
Practice Address - Street 1:1260 S HOVER ST
Practice Address - Street 2:STE D
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7911
Practice Address - Country:US
Practice Address - Phone:303-652-0900
Practice Address - Fax:720-907-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty