Healthcare Provider Details

I. General information

NPI: 1477658052
Provider Name (Legal Business Name): MOREA CHIROPRACTIC WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 N 3RD AVE SUITE L
FRUITPORT MI
49415-9785
US

IV. Provider business mailing address

388 N 3RD AVE SUITE L
FRUITPORT MI
49415-9785
US

V. Phone/Fax

Practice location:
  • Phone: 231-865-7474
  • Fax: 231-865-7484
Mailing address:
  • Phone: 231-865-7474
  • Fax: 231-865-7484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL MOREA
Title or Position: OWNER
Credential: DC
Phone: 231-865-7474