Healthcare Provider Details

I. General information

NPI: 1144709098
Provider Name (Legal Business Name): OGEMAW CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 S M 76
WEST BRANCH MI
48661
US

IV. Provider business mailing address

2333 S M 76
WEST BRANCH MI
48661-9380
US

V. Phone/Fax

Practice location:
  • Phone: 989-345-0010
  • Fax: 989-345-0014
Mailing address:
  • Phone: 989-345-0010
  • Fax: 989-345-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009642
License Number StateMI

VIII. Authorized Official

Name: DR. STEPHANIE MARIE WITTE-MASON
Title or Position: OWNER/DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 989-345-0010