Provider Demographics
NPI:1053643718
Name:TOTAL HEALTH ZONE SC
Entity Type:Organization
Organization Name:TOTAL HEALTH ZONE SC
Other - Org Name:NOWICKI CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NOWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-779-1300
Mailing Address - Street 1:W8065 S US HIGHWAY 2/141
Mailing Address - Street 2:SUITE 1
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-9494
Mailing Address - Country:US
Mailing Address - Phone:906-779-1300
Mailing Address - Fax:906-779-1333
Practice Address - Street 1:W8065 S US HIGHWAY 2/141
Practice Address - Street 2:SUITE 1
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-9494
Practice Address - Country:US
Practice Address - Phone:906-779-1300
Practice Address - Fax:906-779-1333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL HEALTH ZONE SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-05
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2341-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035131OtherMEDICARE ID
MI4217348Medicaid
WI38844000Medicaid
WI000035131OtherMEDICARE ID