Provider Demographics
NPI:1750033767
Name:LEGACY FAMILY CHIROPRACTIC & WELLNESS PLLC
Entity Type:Organization
Organization Name:LEGACY FAMILY CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREEV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-560-7971
Mailing Address - Street 1:547 N PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3442
Mailing Address - Country:US
Mailing Address - Phone:248-560-7971
Mailing Address - Fax:
Practice Address - Street 1:547 N PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3442
Practice Address - Country:US
Practice Address - Phone:248-560-7971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty