Healthcare Provider Details

I. General information

NPI: 1558601419
Provider Name (Legal Business Name): PHYSICIANS WELLNESS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 S SAGINAW ST SUITE 1465
FLINT MI
48507-2645
US

IV. Provider business mailing address

4400 S SAGINAW ST SUITE 1465
FLINT MI
48507-2645
US

V. Phone/Fax

Practice location:
  • Phone: 810-869-9939
  • Fax:
Mailing address:
  • Phone: 810-869-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008370
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501006306
License Number StateMI

VIII. Authorized Official

Name: DR. KEITH RANDALL DENNING
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 810-869-9939