Provider Demographics
NPI:1477952737
Name:BRAIN & BODY FAMILY HEALTH CENTER P.C.
Entity Type:Organization
Organization Name:BRAIN & BODY FAMILY HEALTH CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER, SECRETARY, CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENGLI
Authorized Official - Middle Name:LILY
Authorized Official - Last Name:SEMROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-885-3227
Mailing Address - Street 1:833 E 16TH ST
Mailing Address - Street 2:STE 175, UNIT A
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:833 E 16TH ST
Practice Address - Street 2:STE 175, UNIT A
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-9257
Practice Address - Country:US
Practice Address - Phone:770-885-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010079111N00000X
MI2301010197111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty