Provider Demographics
NPI:1043626500
Name:WELLNESS GROUP OF MARICOPA
Entity type:Organization
Organization Name:WELLNESS GROUP OF MARICOPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALLI
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-969-2425
Mailing Address - Street 1:1925 E BROWN RD
Mailing Address - Street 2:A1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-5135
Mailing Address - Country:US
Mailing Address - Phone:480-969-2425
Mailing Address - Fax:480-969-5524
Practice Address - Street 1:1925 E BROWN RD
Practice Address - Street 2:A1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5135
Practice Address - Country:US
Practice Address - Phone:480-969-2425
Practice Address - Fax:480-969-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-05
Last Update Date:2014-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty