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General NPI Number Information
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NPI Number | 1174771570
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Entity Type | Organization
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Legal Business Name | SUPERIOR HEALTH & WELLNESS
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 502 W HARRIE ST
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City | NEWBERRY
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State | MI
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Zip | 49868-1209
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Country | US
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Telephone | 906-293-9248
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Fax | 906-293-9172
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Provider Business Mailing Address
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Address Line | 423N S LAKE MICHIGAN RD
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City | GULLIVER
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State | MI
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Zip | 49840-9038
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Country | US
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Telephone | 906-283-0203
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTIN ANNE MCDONOUGH
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Credential | D.C.
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Telephone | 414-758-7331
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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 | 2301009094
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License Number State | MI
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