Healthcare Provider Details

I. General information

NPI: 1457522385
Provider Name (Legal Business Name): WHITE LAKE CHIROPRACTIC CENTRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S MEARS AVE SUITE A
WHITEHALL MI
49461-1779
US

IV. Provider business mailing address

1030 S MEARS AVE SUITE A
WHITEHALL MI
49461-1779
US

V. Phone/Fax

Practice location:
  • Phone: 231-893-1755
  • Fax: 231-893-3595
Mailing address:
  • Phone: 231-893-1755
  • Fax: 231-893-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301003057
License Number StateMI

VIII. Authorized Official

Name: DR. RANDY D BROWN
Title or Position: PRESIDENT
Credential: DC
Phone: 231-893-1755