Provider Demographics
NPI:1902135494
Name:WHOLISTIC WELLNESS CLINIC
Entity type:Organization
Organization Name:WHOLISTIC WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-360-4121
Mailing Address - Street 1:382 EAST POST RD SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403
Mailing Address - Country:US
Mailing Address - Phone:319-360-4121
Mailing Address - Fax:319-365-1146
Practice Address - Street 1:693 MARION BLVD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302
Practice Address - Country:US
Practice Address - Phone:319-365-1141
Practice Address - Fax:319-365-1146
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHOLISTIC WELLNESS CLINIC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-14
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU36860Medicare UPIN