Provider Demographics
NPI:1811226814
Name:WELLNESS 4 LIFE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:WELLNESS 4 LIFE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-632-5252
Mailing Address - Street 1:11202 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2704
Mailing Address - Country:US
Mailing Address - Phone:810-632-5252
Mailing Address - Fax:810-632-7575
Practice Address - Street 1:11202 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2704
Practice Address - Country:US
Practice Address - Phone:810-632-5252
Practice Address - Fax:810-632-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty