Provider Demographics
NPI:1215399217
Name:PHOENIX RISING: ADRIAN WELLNESS CENTER
Entity Type:Organization
Organization Name:PHOENIX RISING: ADRIAN WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURE PHYSICIA
Authorized Official - Phone:517-759-4018
Mailing Address - Street 1:101 W MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2019
Mailing Address - Country:US
Mailing Address - Phone:517-759-4018
Mailing Address - Fax:
Practice Address - Street 1:101 W MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2019
Practice Address - Country:US
Practice Address - Phone:517-759-4018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty