Provider Demographics
NPI:1659599934
Name:CHIROPRACTIC WELLNESS CTR INC
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:BLUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-773-9355
Mailing Address - Street 1:1524 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2933
Mailing Address - Country:US
Mailing Address - Phone:989-773-9355
Mailing Address - Fax:989-773-5594
Practice Address - Street 1:1524 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2933
Practice Address - Country:US
Practice Address - Phone:989-773-9355
Practice Address - Fax:989-773-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI004182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C710570OtherBCBS
MI0C75007Medicare PIN
MI950C710570OtherBCBS