Provider Demographics
NPI:1174810212
Name:L. MICHELLE WELLNESS, LLC.
Entity type:Organization
Organization Name:L. MICHELLE WELLNESS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETEET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-871-4902
Mailing Address - Street 1:11925 E 65TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-3178
Mailing Address - Country:US
Mailing Address - Phone:317-871-4902
Mailing Address - Fax:317-663-4775
Practice Address - Street 1:11925 E 65TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-3178
Practice Address - Country:US
Practice Address - Phone:317-871-4902
Practice Address - Fax:317-663-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002481A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty