Provider Demographics
NPI:1750447041
Name:CHAPPELL CHIROPRACTIC WELLNESS CENTER PC
Entity Type:Organization
Organization Name:CHAPPELL CHIROPRACTIC WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-938-3830
Mailing Address - Street 1:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:MI
Mailing Address - Zip Code:49610-1649
Mailing Address - Country:US
Mailing Address - Phone:231-938-3830
Mailing Address - Fax:231-938-3831
Practice Address - Street 1:3875 M72 EAST
Practice Address - Street 2:
Practice Address - City:ACME
Practice Address - State:MI
Practice Address - Zip Code:49610
Practice Address - Country:US
Practice Address - Phone:231-938-3830
Practice Address - Fax:231-938-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGC007695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M65940Medicare ID - Type Unspecified