Provider Demographics
NPI:1073812046
Name:CHIROPRACTIC WELLNESS CENTER PC
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-785-7970
Mailing Address - Street 1:6410 ALPINE AVE NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8001
Mailing Address - Country:US
Mailing Address - Phone:616-785-7970
Mailing Address - Fax:616-785-7973
Practice Address - Street 1:6410 ALPINE AVE NW
Practice Address - Street 2:SUITE C
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8001
Practice Address - Country:US
Practice Address - Phone:616-785-7970
Practice Address - Fax:616-785-7973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty