Provider Demographics
NPI:1134505795
Name:RIVER OF LIFE CHIROPRACTIC AND WELLNESS PLLC
Entity Type:Organization
Organization Name:RIVER OF LIFE CHIROPRACTIC AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. CALEB HALULKO D.C.
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:HALULKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-946-9246
Mailing Address - Street 1:827 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2465
Mailing Address - Country:US
Mailing Address - Phone:231-946-9246
Mailing Address - Fax:
Practice Address - Street 1:827 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2465
Practice Address - Country:US
Practice Address - Phone:231-946-9246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty