Provider Demographics
NPI:1528246667
Name:HEALTHWISE CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:HEALTHWISE CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDER SANDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-243-3052
Mailing Address - Street 1:1314 W COLLEGE AVE
Mailing Address - Street 2:UNIT 6
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-4973
Mailing Address - Country:US
Mailing Address - Phone:920-733-9999
Mailing Address - Fax:920-733-9998
Practice Address - Street 1:1314 W COLLEGE AVE
Practice Address - Street 2:UNIT 6
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-4973
Practice Address - Country:US
Practice Address - Phone:920-733-9999
Practice Address - Fax:920-733-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty