Provider Demographics
NPI:1083256390
Name:SPINE & WELLNESS INSTITUTE, PLLC
Entity Type:Organization
Organization Name:SPINE & WELLNESS INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TY ALAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MCCUEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-279-2342
Mailing Address - Street 1:160 DIVISION ST STE E
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2914
Mailing Address - Country:US
Mailing Address - Phone:517-279-2342
Mailing Address - Fax:
Practice Address - Street 1:160 DIVISION ST STE E
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2914
Practice Address - Country:US
Practice Address - Phone:517-279-2342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty