Provider Demographics
NPI:1861743148
Name:ROUTE 2 WELLNESS, P.C.
Entity type:Organization
Organization Name:ROUTE 2 WELLNESS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-696-9816
Mailing Address - Street 1:2072B E COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-2116
Mailing Address - Country:US
Mailing Address - Phone:219-696-8916
Mailing Address - Fax:219-696-6880
Practice Address - Street 1:2072B E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2116
Practice Address - Country:US
Practice Address - Phone:219-696-8916
Practice Address - Fax:219-696-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0800252A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty