Provider Demographics
NPI:1457618696
Name:AAA WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:AAA WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:KEMOLI
Authorized Official - Last Name:SAGALA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-956-6285
Mailing Address - Street 1:27553 W. WARREN RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2235
Mailing Address - Country:US
Mailing Address - Phone:734-956-6285
Mailing Address - Fax:734-956-6287
Practice Address - Street 1:27553 W. WARREN
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2235
Practice Address - Country:US
Practice Address - Phone:734-956-6285
Practice Address - Fax:734-956-6287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty