Organization Active NPI

Omni Wellness Center PLLC

Doing business as Omni Wellness Center

  • Chiropractor
  • Charlotte, NC
National Provider Identifier
1639350770
Registry record updated Dec 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
OMNI WELLNESS CENTER PLLC
Doing business as
Omni Wellness Center
Practice address
10220 Couloak Dr
Charlotte, NC 28216-7678
Phone
(704) 392-9999
Fax
(704) 392-9913
NPI assigned
Nov 16, 2007
Last updated
Dec 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tyshia Allen, DCNPI 1811485378
Title
Owner
Phone
(704) 392-9999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

10220 Couloak Dr
Charlotte, NC 28216-7678

Mailing address

10220 Couloak Dr
Charlotte, NC 28216-7678
Phone (704) 392-9999

Other identifiers 3

IdentifierTypeStateIssuer
1679068464MedicaidNC
1811485378MedicaidNC
5908653MedicaidNC

Other names 1

  • Omni Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080516000318 NC Part B Supplier - Clinic/Group Practice 7911076914 Receives reassigned benefits from 3 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Locations

10030 Callabridge Ct
Ste C
Charlotte, NC 28216
Phone (704) 392-9999

10220 Couloak Dr
Charlotte, NC 28216
Phone (704) 392-9999

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765324800000",
    "number": "1639350770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10220 COULOAK DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282167678",
            "telephone_number": "704-392-9999",
            "fax_number": "704-392-9913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10220 COULOAK DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282167678",
            "telephone_number": "704-392-9999",
            "fax_number": "704-392-9913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI WELLNESS CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "TYSHIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-392-9999",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679068464",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811485378",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5908653",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omni Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.