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NPI Code Detail

MEDICARE: PHOENIX WELLNESS CENTERS, INC

MEDICARE: PHOENIX WELLNESS CENTERS, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NN1001XNutrition Chiropractor2301007576MI

General Provider Information

NPI Number : 1023298403
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENIX WELLNESS CENTERS, INC
Provider Business Mailing Address
First Line : 1203 E EIGHTH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-2938
Country : US
Telephone Number : 231-938-8000
Fax Number : 231-938-0547
Provider Business Practice Location Address
First Line : 1203 E EIGHTH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-2938
Country : US
Telephone Number : 231-938-8000
Fax Number : 231-938-0547
Authorized Official
Title or Position : PRESIDENT
Name : DR. CHARLES HOWARD LANGE
Credential : D.C
Telephone Number : 231-938-8000
Provider Enumeration Date : 11/14/2007
Last Update Date : 06/20/2011

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Directions to “PHOENIX WELLNESS CENTERS, INC ” Practice Location

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