Provider Demographics
NPI:1710149844
Name:VILLAGE CHIROPRACTIC WELLNESS CENTER, PLC
Entity Type:Organization
Organization Name:VILLAGE CHIROPRACTIC WELLNESS CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OOSTERHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-258-4023
Mailing Address - Street 1:798 W MILE RD NW
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-8431
Mailing Address - Country:US
Mailing Address - Phone:231-258-4023
Mailing Address - Fax:231-258-3291
Practice Address - Street 1:798 W MILE RD NW
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-8431
Practice Address - Country:US
Practice Address - Phone:231-258-4023
Practice Address - Fax:231-258-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty