Provider Demographics
NPI:1194187567
Name:OUILLETTE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:OUILLETTE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:OUILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-324-9778
Mailing Address - Street 1:8082 GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9341
Mailing Address - Country:US
Mailing Address - Phone:810-295-2200
Mailing Address - Fax:
Practice Address - Street 1:8082 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9341
Practice Address - Country:US
Practice Address - Phone:810-295-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty