Healthcare Provider Details

I. General information

NPI: 1881194579
Provider Name (Legal Business Name): NOVI HOLISTIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 10/12/2023
Certification Date: 01/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 S DEXTER ST
PINCKNEY MI
48169-9070
US

IV. Provider business mailing address

422 S DEXTER ST
PINCKNEY MI
48169-9070
US

V. Phone/Fax

Practice location:
  • Phone: 734-878-3113
  • Fax:
Mailing address:
  • Phone: 734-878-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2301009946
License Number StateMI

VIII. Authorized Official

Name: ASHLEY ELIZABETH STALMACK
Title or Position: OWNER
Credential: DC
Phone: 734-878-3113