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General NPI Number Information
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NPI Number | 1104337211
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Entity Type | Organization
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Legal Business Name | EAST WEST LIFE SOLUTIONS INC.
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 221 S MILL ST
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City | CLIO
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State | MI
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Zip | 48420-2324
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Country | US
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Telephone | 810-522-3095
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Fax |
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Provider Business Mailing Address
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Address Line | 14543 BLUE HERON DR
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City | FENTON
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State | MI
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Zip | 48430-3268
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Country | US
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Telephone | 810-522-3095
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LAMBROS NICHOLAS KOTTALIS
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Credential | DC
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Telephone | 810-522-3095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009759
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License Number State | MI
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