Provider Demographics
NPI:1578649190
Name:STRAITS AREA CHIROPRACTIC WELLNESS CENTERS, PLLC
Entity Type:Organization
Organization Name:STRAITS AREA CHIROPRACTIC WELLNESS CENTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-597-9999
Mailing Address - Street 1:401 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1622
Mailing Address - Country:US
Mailing Address - Phone:231-597-9999
Mailing Address - Fax:231-597-1042
Practice Address - Street 1:401 W ELM ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1622
Practice Address - Country:US
Practice Address - Phone:231-597-9999
Practice Address - Fax:231-597-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008274111N00000X
MI2301008412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI444G220Medicaid
MI4440211Medicaid
MI4440211Medicaid
MI444G220Medicaid