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General NPI Number Information
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NPI Number | 1134505795
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Entity Type | Organization
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Legal Business Name | RIVER OF LIFE CHIROPRACTIC AND WELLNESS PLLC
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 827 W FRONT ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2465
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Country | US
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Telephone | 231-946-9246
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Fax |
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Provider Business Mailing Address
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Address Line | 827 W FRONT ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2465
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Country | US
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Telephone | 231-946-9246
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Fax |
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Authorized Official
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Title or Position | DR. CALEB HALULKO D.C.
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Name | CALEB HALULKO
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Credential | D.C.
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Telephone | 231-946-9246
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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 | 2301010291
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License Number State | MI
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