Provider Demographics
NPI:1205121472
Name:SERENITY WELLNESS PLC
Entity type:Organization
Organization Name:SERENITY WELLNESS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNMARIE
Authorized Official - Middle Name:SKIPPER
Authorized Official - Last Name:LEYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-887-2178
Mailing Address - Street 1:542 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-1547
Mailing Address - Country:US
Mailing Address - Phone:616-887-2178
Mailing Address - Fax:616-887-2456
Practice Address - Street 1:542 S STATE ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-1547
Practice Address - Country:US
Practice Address - Phone:616-887-2178
Practice Address - Fax:616-887-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty