Provider Demographics
NPI:1215406186
Name:NOVO CHIROPRACTIC 131 SOUTH PLLC
Entity Type:Organization
Organization Name:NOVO CHIROPRACTIC 131 SOUTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONYNENBELT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-258-9880
Mailing Address - Street 1:1851 44TH ST SW STE N
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-6440
Mailing Address - Country:US
Mailing Address - Phone:616-538-9880
Mailing Address - Fax:
Practice Address - Street 1:1851 44TH ST SW STE N
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-6440
Practice Address - Country:US
Practice Address - Phone:616-538-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty