Provider Demographics
NPI:1558601419
Name:PHYSICIANS WELLNESS GROUP
Entity Type:Organization
Organization Name:PHYSICIANS WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:DENNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-869-9939
Mailing Address - Street 1:4400 S SAGINAW ST
Mailing Address - Street 2:SUITE 1465
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2645
Mailing Address - Country:US
Mailing Address - Phone:810-869-9939
Mailing Address - Fax:
Practice Address - Street 1:4400 S SAGINAW ST
Practice Address - Street 2:SUITE 1465
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2645
Practice Address - Country:US
Practice Address - Phone:810-869-9939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008370111N00000X
MI5501006306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty