Healthcare Provider Details

I. General information

NPI: 1275385205
Provider Name (Legal Business Name): INNOVATIVE HEALTH & CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 CROSSINGS DR SE STE B
GRAND RAPIDS MI
49508
US

IV. Provider business mailing address

6651 CROSSINGS DR SE STE B
GRAND RAPIDS MI
49508-7894
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-8161
  • Fax: 616-920-6555
Mailing address:
  • Phone: 616-888-8161
  • Fax: 616-920-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM C WELLMAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 616-888-8161