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General NPI Number Information
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NPI Number | 1548467467
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Entity Type | Organization
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Legal Business Name | BELLEVILLE CHIROPRACTIC WELLNESS CLINIC PLC
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 10800 BELLEVILLE RD
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City | BELLEVILLE
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State | MI
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Zip | 48111-5304
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Country | US
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Telephone | 734-697-3210
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Fax | 734-697-5603
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Provider Business Mailing Address
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Address Line | 10800 BELLEVILLE RD
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City | BELLEVILLE
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State | MI
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Zip | 48111-5304
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Country | US
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Telephone | 734-697-3210
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Fax | 734-697-5603
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLENN A SISK
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Credential | D.C.
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Telephone | 734-697-3210
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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 | GS006907
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License Number State | MI
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