Provider Demographics
NPI:1558824581
Name:IN-HOME FAMILY WELLNESS
Entity Type:Organization
Organization Name:IN-HOME FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-666-3722
Mailing Address - Street 1:5433 DIXIE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1614
Mailing Address - Country:US
Mailing Address - Phone:810-634-0400
Mailing Address - Fax:
Practice Address - Street 1:5433 DIXIE HWY STE 205
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-1614
Practice Address - Country:US
Practice Address - Phone:810-634-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty