Healthcare Provider Details

I. General information

NPI: 1043159874
Provider Name (Legal Business Name): MICHIGAN SPINE & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S CAPITAL AVE
ATHENS MI
49011-5102
US

IV. Provider business mailing address

101 S CAPITAL AVE
ATHENS MI
49011-5102
US

V. Phone/Fax

Practice location:
  • Phone: 269-924-9463
  • Fax:
Mailing address:
  • Phone: 269-924-9463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER SMITTENDORF
Title or Position: PRESIDENT
Credential: DC
Phone: 269-924-9463