Provider Demographics
NPI:1053012583
Name:PREMIER CARE WELLNESS COMPANY
Entity type:Organization
Organization Name:PREMIER CARE WELLNESS COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:971-544-7058
Mailing Address - Street 1:524 SE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2428
Mailing Address - Country:US
Mailing Address - Phone:971-544-7058
Mailing Address - Fax:971-244-9058
Practice Address - Street 1:524 SE 14TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2428
Practice Address - Country:US
Practice Address - Phone:971-544-7058
Practice Address - Fax:971-244-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty