Provider Demographics
NPI:1063841278
Name:THRIVE WELLNESS CENTER PC
Entity Type:Organization
Organization Name:THRIVE WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZNAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-470-6766
Mailing Address - Street 1:6901 STATE RD
Mailing Address - Street 2:STE D
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-8930
Mailing Address - Country:US
Mailing Address - Phone:734-470-6766
Mailing Address - Fax:
Practice Address - Street 1:6901 STATE RD
Practice Address - Street 2:STE D
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-8930
Practice Address - Country:US
Practice Address - Phone:734-470-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008957111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP36370002Medicare PIN