Provider Demographics
NPI:1316709025
Name:OZARK WELLNESS
Entity type:Organization
Organization Name:OZARK WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICODEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-607-0025
Mailing Address - Street 1:1245 BEE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72131-9647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1245 BEE BRANCH RD
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:AR
Practice Address - Zip Code:72131-9647
Practice Address - Country:US
Practice Address - Phone:501-607-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty