Provider Demographics
NPI:1992126007
Name:HOMETOWN WELLNESS, PC
Entity type:Organization
Organization Name:HOMETOWN WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-878-4300
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:ND
Mailing Address - Zip Code:58638-0031
Mailing Address - Country:US
Mailing Address - Phone:701-878-4300
Mailing Address - Fax:
Practice Address - Street 1:725 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:ND
Practice Address - Zip Code:58638-7056
Practice Address - Country:US
Practice Address - Phone:701-878-4300
Practice Address - Fax:701-878-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN716881OtherINDIVIDUAL PTAN NUMBER
ND1902059926OtherINDIVIDUAL NPI NUMBER