Provider Demographics
NPI:1740319102
Name:BIRMINGHAM WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:BIRMINGHAM WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TURNBULL-BONDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-645-6070
Mailing Address - Street 1:219 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6341
Mailing Address - Country:US
Mailing Address - Phone:248-645-6070
Mailing Address - Fax:248-645-2949
Practice Address - Street 1:219 ELM ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6341
Practice Address - Country:US
Practice Address - Phone:248-645-6070
Practice Address - Fax:248-645-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F33870OtherBCBS OF MI PROVIDER NUMBER
MI0F33870OtherBCBS OF MI PROVIDER NUMBER