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General NPI Number Information
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NPI Number | 1194981753
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Entity Type | Organization
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Legal Business Name | KMWA, LLC
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 6575 BELDING RD NE SUITE C
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City | ROCKFORD
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State | MI
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Zip | 49341-7418
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Country | US
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Telephone | 616-874-8777
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Fax | 616-874-8835
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Provider Business Mailing Address
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Address Line | 6575 BELDING RD NE SUITE C
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City | ROCKFORD
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State | MI
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Zip | 49341-7418
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Country | US
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Telephone | 616-874-8777
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Fax | 616-874-8835
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Authorized Official
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Title or Position | MEMBER
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Name | DR. LORI LYNN WALENGA
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Credential | D.C.
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Telephone | 616-874-8777
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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 | 2301009047
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License Number State | MI
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