Provider Demographics
NPI:1881821486
Name:HURON WELLNESS PROFESSIONAL LIMITED
Entity Type:Organization
Organization Name:HURON WELLNESS PROFESSIONAL LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-284-4995
Mailing Address - Street 1:718 GRISWOLD ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5847
Mailing Address - Country:US
Mailing Address - Phone:810-824-4995
Mailing Address - Fax:810-824-4998
Practice Address - Street 1:718 GRISWOLD ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5847
Practice Address - Country:US
Practice Address - Phone:810-824-4995
Practice Address - Fax:810-824-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty