Provider Demographics
NPI:1174107593
Name:JB WELLNESS PA
Entity type:Organization
Organization Name:JB WELLNESS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDANA
Authorized Official - Middle Name:ELLEN AMELIA
Authorized Official - Last Name:BEUTELSCHIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-414-4336
Mailing Address - Street 1:4015 N RUDY RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-9109
Mailing Address - Country:US
Mailing Address - Phone:479-414-4336
Mailing Address - Fax:
Practice Address - Street 1:139 NORTHRIDGE DR E STE 2
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5184
Practice Address - Country:US
Practice Address - Phone:479-414-4336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty