Healthcare Provider Details

I. General information

NPI: 1043517881
Provider Name (Legal Business Name): PAIN AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27190 CAMPAU LN
HARRISON TOWNSHIP MI
48045-2447
US

IV. Provider business mailing address

27190 CAMPAU LN
HARRISON TOWNSHIP MI
48045-2447
US

V. Phone/Fax

Practice location:
  • Phone: 586-909-2704
  • Fax:
Mailing address:
  • Phone: 586-909-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008179
License Number StateMI

VIII. Authorized Official

Name: DR. STEVEN STANELY WOOD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 586-909-2704