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Organization
GENESIS HEALTH AND WELLNESS LLC
Active
Organization
GENESIS HEALTH AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAUN P TYMCHAK DC (DIRECTOR)
(812) 858-1005
Entity
Organization
Contact information
Practice address
8211 W STATE ROUTE 66, NEWBURGH, IN 47630-2534
(812) 858-1005
(812) 858-1001
Mailing address
8211 W STATE ROUTE 66, NEWBURGH, IN 47630-2534
(812) 858-1005
(812) 858-1001
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
08002011A
IN
208D00000X
General Practice Physician
—
—
332BC3200X
Customized Equipment (DME)
Primary
08002011A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201085220A
—
IN
Enumeration date
01/26/2010
Last updated
08/30/2012
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