Provider Demographics
NPI:1114593043
Name:ROGUE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:ROGUE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAWIETER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-202-6435
Mailing Address - Street 1:6070 GREELEY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8060
Mailing Address - Country:US
Mailing Address - Phone:616-202-6435
Mailing Address - Fax:
Practice Address - Street 1:6070 GREELEY AVE NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8060
Practice Address - Country:US
Practice Address - Phone:616-202-6435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty