Provider Demographics
NPI:1588184915
Name:BEDFORD WELLNESS CLINIC INC
Entity Type:Organization
Organization Name:BEDFORD WELLNESS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUSZCZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-847-9200
Mailing Address - Street 1:1671 W STERNS RD STE F
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1582
Mailing Address - Country:US
Mailing Address - Phone:734-847-9200
Mailing Address - Fax:734-847-7707
Practice Address - Street 1:1671 W STERNS RD STE F
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1582
Practice Address - Country:US
Practice Address - Phone:734-847-9200
Practice Address - Fax:734-847-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty