Provider Demographics
NPI:1649660580
Name:COMPREHENSIVE CHIROPRACTIC WELLNESS
Entity type:Organization
Organization Name:COMPREHENSIVE CHIROPRACTIC WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-291-6462
Mailing Address - Street 1:23300 GREENFIELD RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-5237
Mailing Address - Country:US
Mailing Address - Phone:248-291-6462
Mailing Address - Fax:
Practice Address - Street 1:23300 GREENFIELD RD
Practice Address - Street 2:SUITE 207
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-5237
Practice Address - Country:US
Practice Address - Phone:248-291-6462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL257101111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOQ25142Medicare PIN