Provider Demographics
NPI:1316007909
Name:WARDELL CHIROPRACTIC FAMILY HEALTH CENTER, P.C.
Entity Type:Organization
Organization Name:WARDELL CHIROPRACTIC FAMILY HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-421-4110
Mailing Address - Street 1:28252 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2927
Mailing Address - Country:US
Mailing Address - Phone:734-421-4110
Mailing Address - Fax:734-421-4116
Practice Address - Street 1:28252 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2927
Practice Address - Country:US
Practice Address - Phone:734-421-4110
Practice Address - Fax:734-421-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKW007553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4310208Medicaid
MI4310208Medicaid
MIU68723Medicare UPIN