Healthcare Provider Details

I. General information

NPI: 1649660580
Provider Name (Legal Business Name): COMPREHENSIVE CHIROPRACTIC WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23300 GREENFIELD RD SUITE 207
OAK PARK MI
48237-5237
US

IV. Provider business mailing address

23300 GREENFIELD RD SUITE 207
OAK PARK MI
48237-5237
US

V. Phone/Fax

Practice location:
  • Phone: 248-291-6462
  • Fax:
Mailing address:
  • Phone: 248-291-6462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberL257101
License Number StateMI

VIII. Authorized Official

Name: DR. WILLLIAM NELSON
Title or Position: OWNER
Credential: DC
Phone: 248-291-6462