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General NPI Number Information
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NPI Number | 1194613448
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Entity Type | Organization
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Legal Business Name | ORIGINS COMMUNITY WELLNESS CENTER
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 4004 W ST JOE HWY
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City | LANSING
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State | MI
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Zip | 48917-4215
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Country | US
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Telephone | 517-327-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 6842 OLD VILLAGE CT SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6801
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Country | US
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Telephone | 616-916-7429
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Fax |
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Authorized Official
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Title or Position | CO-CEO
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Name | CHEYANNE BOSS
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Credential |
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Telephone | 616-916-7429
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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 |
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License Number State |
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