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General NPI Number Information
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NPI Number | 1457522385
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Entity Type | Organization
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Legal Business Name | WHITE LAKE CHIROPRACTIC CENTRE INC
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 1030 S MEARS AVE SUITE A
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City | WHITEHALL
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State | MI
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Zip | 49461-1779
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Country | US
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Telephone | 231-893-1755
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Fax | 231-893-3595
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Provider Business Mailing Address
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Address Line | 1030 S MEARS AVE SUITE A
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City | WHITEHALL
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State | MI
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Zip | 49461-1779
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Country | US
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Telephone | 231-893-1755
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Fax | 231-893-3595
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY D BROWN
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Credential | DC
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Telephone | 231-893-1755
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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 | 2301003057
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License Number State | MI
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