Provider Demographics
NPI:1083836829
Name:PAIN & WELLNESS CENTER, L.L.C
Entity Type:Organization
Organization Name:PAIN & WELLNESS CENTER, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-790-7400
Mailing Address - Street 1:35426 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3205
Mailing Address - Country:US
Mailing Address - Phone:586-790-7400
Mailing Address - Fax:
Practice Address - Street 1:35426 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-3205
Practice Address - Country:US
Practice Address - Phone:586-790-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISW301008179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E014740OtherBCBS
MI106427OtherPPOM
MI4944693Medicaid
MI4944693Medicaid
MIU87904Medicare UPIN