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General NPI Number Information
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NPI Number | 1548735277
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Entity Type | Organization
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Legal Business Name | PROSPER HEALTH LLC
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Dates
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Enumeration Date | 10/09/2018
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 5228 LOVERS LN STE 110
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City | PORTAGE
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State | MI
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Zip | 49002-1521
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Country | US
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Telephone | 269-312-8648
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Fax | 269-585-6293
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Provider Business Mailing Address
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Address Line | 5228 LOVERS LN STE 110
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City | PORTAGE
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State | MI
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Zip | 49002-1521
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Country | US
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Telephone | 269-312-8648
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Fax | 269-585-6293
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Authorized Official
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Title or Position | CEO/LEAD CLINICIAN
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Name | DR. RYAN MICHAEL BALL
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Credential | DC
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Telephone | 269-312-8648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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