Provider Demographics
NPI:1376755918
Name:MIRACLE SALON & SPA DBA NATURAL WELLNESS
Entity Type:Organization
Organization Name:MIRACLE SALON & SPA DBA NATURAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:734-850-9355
Mailing Address - Street 1:6632 SUMMERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1339
Mailing Address - Country:US
Mailing Address - Phone:734-850-9355
Mailing Address - Fax:734-850-9356
Practice Address - Street 1:6632 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1339
Practice Address - Country:US
Practice Address - Phone:734-850-9355
Practice Address - Fax:734-850-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10293172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty