Healthcare Provider Details

I. General information

NPI: 1962713644
Provider Name (Legal Business Name): BROWN CITY WELLNESS CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 MAIN ST
BROWN CITY MI
48416-9701
US

IV. Provider business mailing address

4444 MAIN ST
BROWN CITY MI
48416-9701
US

V. Phone/Fax

Practice location:
  • Phone: 810-346-4300
  • Fax: 810-346-4304
Mailing address:
  • Phone: 810-346-4300
  • Fax: 810-346-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009587
License Number StateMI

VIII. Authorized Official

Name: MR. SCOTT ROBERT BANKS
Title or Position: PRESIDENT
Credential:
Phone: 810-537-1156