Provider Demographics
NPI:1235211426
Name:WAY OF LIFE HEALTH & WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:WAY OF LIFE HEALTH & WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-310-1101
Mailing Address - Street 1:3355 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4551
Mailing Address - Country:US
Mailing Address - Phone:248-242-2123
Mailing Address - Fax:
Practice Address - Street 1:3355 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4551
Practice Address - Country:US
Practice Address - Phone:248-242-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F39764OtherBCBS
MILM008198Medicaid
MI0P36550Medicare UPIN