Provider Demographics
NPI:1750487948
Name:FAMILY WELLNESS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:FAMILY WELLNESS CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LASICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:906-226-9355
Mailing Address - Street 1:1465 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3115
Mailing Address - Country:US
Mailing Address - Phone:906-226-9355
Mailing Address - Fax:906-226-9412
Practice Address - Street 1:1465 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3115
Practice Address - Country:US
Practice Address - Phone:906-226-9355
Practice Address - Fax:906-226-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E210990OtherBCBS OF MI
MI950E210990OtherBCBS OF MI
MI0M79900Medicare PIN