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General NPI Number Information
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NPI Number | 1386032357
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Entity Type | Organization
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Legal Business Name | STAYWELL SPINE AND JOINT SPECIALISTS LLC
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 26200 TOWN CENTER DR STE 165
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City | NOVI
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State | MI
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Zip | 48375-1219
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Country | US
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Telephone | 248-513-3100
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Fax | 248-679-3061
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Provider Business Mailing Address
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Address Line | 26200 TOWN CENTER DR STE 165
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City | NOVI
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State | MI
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Zip | 48375-1219
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Country | US
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Telephone | 248-513-3100
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Fax | 248-679-3061
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMY OLSON
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Credential | D.C.
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Telephone | 248-513-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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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 |
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License Number State |
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