Provider Demographics
NPI:1922266063
Name:CONANT HEALTH AND WELLNESS CENTER PC
Entity Type:Organization
Organization Name:CONANT HEALTH AND WELLNESS CENTER PC
Other - Org Name:OPTIMAL HEALTH CHIROPRACTIC OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CONANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-384-3933
Mailing Address - Street 1:15555 S TELEGRAPH RD STE 6
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-4000
Mailing Address - Country:US
Mailing Address - Phone:734-384-3933
Mailing Address - Fax:734-430-8199
Practice Address - Street 1:15555 S TELEGRAPH RD STE 6
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-4000
Practice Address - Country:US
Practice Address - Phone:734-384-3933
Practice Address - Fax:734-430-8199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4716544Medicaid
MI4716544Medicaid
OP10820Medicare PIN