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General NPI Number Information
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NPI Number | 1316486020
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Entity Type | Organization
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Legal Business Name | HEALING LOTUS CENTER
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 77 BAGLEY ST
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City | PONTIAC
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State | MI
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Zip | 48341-2271
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Country | US
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Telephone | 248-702-5080
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Fax |
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Provider Business Mailing Address
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Address Line | 77 BAGLEY ST
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City | PONTIAC
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State | MI
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Zip | 48341-2271
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIRORPACTOR
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Name | DR. SHERTERICA HALL
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Credential | DC
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Telephone | 248-702-5080
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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 | 2301010473
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License Number State | MI
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