Healthcare Provider Details

I. General information

NPI: 1538600697
Provider Name (Legal Business Name): WELLNESS ROOTS CHIROPRACTIC & NUTRITION CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 JACKSON RD STE F
ANN ARBOR MI
48103
US

IV. Provider business mailing address

6360 JACKSON RD STE F
ANN ARBOR MI
48103
US

V. Phone/Fax

Practice location:
  • Phone: 734-369-9990
  • Fax: 734-661-0784
Mailing address:
  • Phone: 734-369-9990
  • Fax: 734-661-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009904
License Number StateMI

VIII. Authorized Official

Name: KATHERINE EISELE
Title or Position: OWNER/DOCTOR/PRESIDENT
Credential: D.C
Phone: 734-369-9990