Provider Demographics
NPI:1487297354
Name:INDEPENDENT WELLNESS CENTER
Entity type:Organization
Organization Name:INDEPENDENT WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-983-5060
Mailing Address - Street 1:1000 W APACHE TRL STE 108
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-5403
Mailing Address - Country:US
Mailing Address - Phone:480-983-5060
Mailing Address - Fax:480-983-5070
Practice Address - Street 1:1000 W APACHE TRL STE 108
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-5403
Practice Address - Country:US
Practice Address - Phone:480-983-5060
Practice Address - Fax:480-983-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care