Healthcare Provider Details

I. General information

NPI: 1912247743
Provider Name (Legal Business Name): JIVANTA CHIROPRACTIC WELLNESS CENTRE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1235 WOODMERE AVE
TRAVERSE CITY MI
49686-4249
US

IV. Provider business mailing address

1235 WOODMERE AVE
TRAVERSE CITY MI
49686-4249
US

V. Phone/Fax

Practice location:
  • Phone: 231-941-8808
  • Fax: 231-941-8690
Mailing address:
  • Phone: 231-941-8808
  • Fax: 231-941-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005809
License Number StateMI

VIII. Authorized Official

Name: DR. GEORGE RICHARD PLUHAR
Title or Position: PRESIDENT
Credential: D.C.
Phone: 231-941-8808