Healthcare Provider Details

I. General information

NPI: 1831579671
Provider Name (Legal Business Name): LUCEY CHIROPRACTIC AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6504 28TH ST SE SUITE H
GRAND RAPIDS MI
49546-6959
US

IV. Provider business mailing address

6504 28TH ST SE SUITE H
GRAND RAPIDS MI
49546-6959
US

V. Phone/Fax

Practice location:
  • Phone: 989-390-5799
  • Fax: 616-228-8778
Mailing address:
  • Phone: 989-390-5799
  • Fax: 616-228-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010031
License Number StateMI

VIII. Authorized Official

Name: DR. BENJAMIN LUCEY
Title or Position: OWNER
Credential: D.C.
Phone: 989-390-5799