Provider Demographics
NPI:1689770224
Name:DEVARY CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:DEVARY CHIROPRACTIC WELLNESS CENTER
Other - Org Name:WELL ADJUSTED CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:DEVARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-515-3176
Mailing Address - Street 1:1121 N SAGINAW ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1380
Mailing Address - Country:US
Mailing Address - Phone:248-328-9291
Mailing Address - Fax:248-328-0944
Practice Address - Street 1:1121 N SAGINAW ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1380
Practice Address - Country:US
Practice Address - Phone:248-328-9291
Practice Address - Fax:248-328-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F327630OtherBCBSM
MI950F327630OtherBCBSM