Provider Demographics
NPI:1639948391
Name:A&W RED ARROW CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:A&W RED ARROW CHIROPRACTIC LLC
Other - Org Name:LIFESTYLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEHAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-463-4100
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-0245
Mailing Address - Country:US
Mailing Address - Phone:269-463-4100
Mailing Address - Fax:269-463-4100
Practice Address - Street 1:7652 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-9396
Practice Address - Country:US
Practice Address - Phone:269-463-4100
Practice Address - Fax:269-463-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty