Healthcare Provider Details

I. General information

NPI: 1609682368
Provider Name (Legal Business Name): MITTEN HEALTH & PERFORMANCE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2024
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RIVER ST STE 203
ELK RAPIDS MI
49629-9605
US

IV. Provider business mailing address

PO BOX 313
ELK RAPIDS MI
49629-0313
US

V. Phone/Fax

Practice location:
  • Phone: 810-931-9478
  • Fax:
Mailing address:
  • Phone: 810-931-9478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALEX CESAL
Title or Position: OWNER/ CHIROPRACTOR
Credential: DC
Phone: 810-931-9478