MEDICARE: DEVARY CHIROPRACTIC WELLNESS CENTER

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
1	111N00000X	Chiropractor		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950F327630	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1689770224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVARY CHIROPRACTIC WELLNESS CENTER

Provider Business Mailing Address
First Line	:	1121 N SAGINAW ST
Second Line	:	SUITE 2
City	:	HOLLY
State	:	MI
Zip	:	48442-1380
Country	:	US
Telephone Number	:	248-328-9291
Fax Number	:	248-328-0944

Provider Business Practice Location Address
First Line	:	1121 N SAGINAW ST
Second Line	:	SUITE 2
City	:	HOLLY
State	:	MI
Zip	:	48442-1380
Country	:	US
Telephone Number	:	248-328-9291
Fax Number	:	248-328-0944

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHAWN ALLAN DEVARY
Credential	:	DC
Telephone Number	:	248-515-3176

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/21/2022

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