Provider Demographics
NPI:1396295952
Name:ENHANCED WELLNESS CLINICS
Entity type:Organization
Organization Name:ENHANCED WELLNESS CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:EISEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-552-7500
Mailing Address - Street 1:6395 MCGINNIS FERRY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3673
Mailing Address - Country:US
Mailing Address - Phone:770-552-7500
Mailing Address - Fax:888-819-9318
Practice Address - Street 1:6395 MCGINNIS FERRY RD STE 301
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-3673
Practice Address - Country:US
Practice Address - Phone:770-552-7500
Practice Address - Fax:888-819-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009680111N00000X
GACHIR009709111N00000X
GACHIR007877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty