MEDICARE: WELLNESS CENTER, PC

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	CS007584	MI

General Provider Information

NPI Number	:	1992857932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS CENTER, PC

Provider Business Mailing Address
First Line	:	1 W MADISON AVE
Second Line	:
City	:	NEW BUFFALO
State	:	MI
Zip	:	49117-1734
Country	:	US
Telephone Number	:	269-469-1310
Fax Number	:	269-469-3969

Provider Business Practice Location Address
First Line	:	1 W MADISON AVE
Second Line	:
City	:	NEW BUFFALO
State	:	MI
Zip	:	49117-1734
Country	:	US
Telephone Number	:	269-469-1310
Fax Number	:	269-469-3969

Authorized Official
Title or Position	:	OWNER CHIROPRACTOR
Name	:	DR. CHARLES BRYAN STROTHER
Credential	:	DC
Telephone Number	:	269-469-1310

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/17/2014

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