Provider Demographics
NPI:1447954037
Name:WRATHALL FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:WRATHALL FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WRATHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-542-2404
Mailing Address - Street 1:154 BROAD ST STE 1536
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-3218
Mailing Address - Country:US
Mailing Address - Phone:603-864-8607
Mailing Address - Fax:
Practice Address - Street 1:154 BROAD ST STE 1536
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3218
Practice Address - Country:US
Practice Address - Phone:603-864-8607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty