Healthcare Provider Details

I. General information

NPI: 1477952737
Provider Name (Legal Business Name): BRAIN & BODY FAMILY HEALTH CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 E 16TH ST STE 175, UNIT A
HOLLAND MI
49423-9257
US

IV. Provider business mailing address

833 E 16TH ST STE 175, UNIT A
HOLLAND MI
49423-9257
US

V. Phone/Fax

Practice location:
  • Phone: 770-885-3227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010079
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number2301010197
License Number StateMI

VIII. Authorized Official

Name: JENGLI LILY SEMROW
Title or Position: TREASURER, SECRETARY, CHIROPRACTOR
Credential: D.C.
Phone: 770-885-3227