Healthcare Provider Details

I. General information

NPI: 1447931266
Provider Name (Legal Business Name): MICHIGAN FAMILY WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N CANTON CENTER RD STE 150
CANTON MI
48187-5037
US

IV. Provider business mailing address

2200 N CANTON CENTER RD STE 150
CANTON MI
48187-5037
US

V. Phone/Fax

Practice location:
  • Phone: 734-335-0533
  • Fax:
Mailing address:
  • Phone: 734-335-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE WALLNER
Title or Position: OWNER
Credential: DC
Phone: 574-948-1312