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General NPI Number Information
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NPI Number | 1528825411
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Entity Type | Organization
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Legal Business Name | WELLNESS WAVE LLC
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 15365 HUBBARD ST
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City | LIVONIA
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State | MI
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Zip | 48154-3147
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Country | US
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Telephone | 734-266-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 7007 ROLLING HILLS DR
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City | WATERFORD
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State | MI
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Zip | 48327-4157
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Country | US
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Telephone | 248-701-9726
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC DILTS
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Credential | DC
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Telephone | 248-701-9726
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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 |
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License Number State |
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