Provider Demographics
NPI:1578838330
Name:FIRST CHOICE WELLNESS OF NORTHVILLE PLLC
Entity Type:Organization
Organization Name:FIRST CHOICE WELLNESS OF NORTHVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-465-0000
Mailing Address - Street 1:41740 6 MILE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3463
Mailing Address - Country:US
Mailing Address - Phone:248-465-0000
Mailing Address - Fax:248-465-0099
Practice Address - Street 1:41740 6 MILE RD
Practice Address - Street 2:STE 100
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3463
Practice Address - Country:US
Practice Address - Phone:248-465-0000
Practice Address - Fax:248-465-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty