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General NPI Number Information
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NPI Number | 1205068269
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Entity Type | Organization
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Legal Business Name | HI-TEC TOTAL WELLNESS, PC
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 2645 BLUEWATER ST
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City | YPSILANTI
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State | MI
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Zip | 48198-1000
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Country | US
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Telephone | 734-478-0281
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Fax | 866-611-1510
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Provider Business Mailing Address
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Address Line | 2645 BLUEWATER ST
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City | YPSILANTI
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State | MI
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Zip | 48198-1000
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Country | US
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Telephone | 734-478-0281
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Fax | 866-611-1510
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. LARRY M ROBISON
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Credential | DC
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Telephone | 734-478-0281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 2301002789
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301002789
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License Number State | MI
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