Provider Demographics
NPI:1770317729
Name:NORTH STAR SPINE AND WELLNESS LLC
Entity type:Organization
Organization Name:NORTH STAR SPINE AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC, CLINIC OWNE
Authorized Official - Prefix:
Authorized Official - First Name:KAMYAB
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-507-9777
Mailing Address - Street 1:1235 CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4808
Mailing Address - Country:US
Mailing Address - Phone:517-507-9777
Mailing Address - Fax:
Practice Address - Street 1:2824 E GRAND RIVER AVE STE C
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4342
Practice Address - Country:US
Practice Address - Phone:517-507-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty