Healthcare Provider Details

I. General information

NPI: 1205068269
Provider Name (Legal Business Name): HI-TEC TOTAL WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 BLUEWATER ST
YPSILANTI MI
48198-1000
US

IV. Provider business mailing address

2645 BLUEWATER ST
YPSILANTI MI
48198-1000
US

V. Phone/Fax

Practice location:
  • Phone: 734-478-0281
  • Fax: 866-611-1510
Mailing address:
  • Phone: 734-478-0281
  • Fax: 866-611-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2301002789
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301002789
License Number StateMI

VIII. Authorized Official

Name: DR. LARRY M ROBISON
Title or Position: PRESIDENT AND CEO
Credential: DC
Phone: 734-478-0281