Provider Demographics
NPI:1437395621
Name:TOTAL WELLNESS INTEGRATED HEALTHCARE CENTERS OF GRAND RAPIDS PLLC
Entity Type:Organization
Organization Name:TOTAL WELLNESS INTEGRATED HEALTHCARE CENTERS OF GRAND RAPIDS PLLC
Other - Org Name:TOTAL WELLNESS OF GRAND RAPIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SILVIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:COZZETTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-458-8063
Mailing Address - Street 1:831 FULLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1901
Mailing Address - Country:US
Mailing Address - Phone:616-458-8062
Mailing Address - Fax:
Practice Address - Street 1:831 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1901
Practice Address - Country:US
Practice Address - Phone:616-458-8062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty