Provider Demographics
NPI:1639881535
Name:NEUROLIFE CENTER PLLC
Entity Type:Organization
Organization Name:NEUROLIFE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-715-7746
Mailing Address - Street 1:4001 WALLI STRASSE DR STE F
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1729
Mailing Address - Country:US
Mailing Address - Phone:810-715-7746
Mailing Address - Fax:810-715-7716
Practice Address - Street 1:4001 WALLI STRASSE DR STE C
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1729
Practice Address - Country:US
Practice Address - Phone:810-715-7746
Practice Address - Fax:810-715-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty