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General NPI Number Information
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NPI Number | 1689951055
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Entity Type | Organization
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Legal Business Name | THE ALTERNATIVE WELLNESS CENTER
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Dates
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Enumeration Date | 11/13/2011
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Last Update Date | 11/13/2011
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Provider Practice Location Address
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Address Line | 920 LAMBERT ST
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City | NILES
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State | MI
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Zip | 49120-3413
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Country | US
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Telephone | 269-684-4200
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Fax | 269-262-0943
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Provider Business Mailing Address
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Address Line | 920 LAMBERT ST
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City | NILES
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State | MI
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Zip | 49120-3413
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Country | US
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Telephone | 269-684-4200
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Fax | 269-262-0943
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTONIO GONZALES
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Credential | D.C.
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Telephone | 269-684-4200
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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 | 2301008841
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License Number State | MI
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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 | 08001868A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 2301008841
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 2301008841
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License Number State | MI
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