Provider Demographics
NPI:1992857932
Name:WELLNESS CENTER, PC
Entity Type:Organization
Organization Name:WELLNESS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:STROTHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-469-1310
Mailing Address - Street 1:1 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BUFFALO
Mailing Address - State:MI
Mailing Address - Zip Code:49117-1734
Mailing Address - Country:US
Mailing Address - Phone:269-469-1310
Mailing Address - Fax:269-469-3969
Practice Address - Street 1:1 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW BUFFALO
Practice Address - State:MI
Practice Address - Zip Code:49117-1734
Practice Address - Country:US
Practice Address - Phone:269-469-1310
Practice Address - Fax:269-469-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS007584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU75270Medicare UPIN
MI0N93640001Medicare PIN