Healthcare Provider Details

I. General information

NPI: 1952931172
Provider Name (Legal Business Name): SPECTRUM CHIROPRACTIC AND HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 RIVERSIDE AVE
ADRIAN MI
49221-1544
US

IV. Provider business mailing address

690 RIVERSIDE AVE
ADRIAN MI
49221-1544
US

V. Phone/Fax

Practice location:
  • Phone: 177-594-1835
  • Fax:
Mailing address:
  • Phone: 177-594-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA KYLE WALLACE
Title or Position: CO-OWNER
Credential: DC
Phone: 517-759-4183