Provider Demographics
NPI:1639532120
Name:LOTUS WELLNESS CENTERS, INC
Entity Type:Organization
Organization Name:LOTUS WELLNESS CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SILVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:COZZETTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-792-6570
Mailing Address - Street 1:750 S OLD WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6600
Mailing Address - Country:US
Mailing Address - Phone:248-215-0115
Mailing Address - Fax:248-792-6574
Practice Address - Street 1:24423 SOUTHFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2864
Practice Address - Country:US
Practice Address - Phone:248-215-0115
Practice Address - Fax:248-792-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008133111N00000X
MI5501014478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty