Provider Demographics
NPI:1275681488
Name:CHIROPRACTIC WELLNESS GROUP PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAJAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-871-3421
Mailing Address - Street 1:38254 CHARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1225
Mailing Address - Country:US
Mailing Address - Phone:586-693-5742
Mailing Address - Fax:586-693-5742
Practice Address - Street 1:2121 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4834
Practice Address - Country:US
Practice Address - Phone:586-871-3421
Practice Address - Fax:810-494-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVB007472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty