=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831528850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHOLE LIFE CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2013
-----------------------------------------------------
Last Update Date | 02/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1168 GRATIOT BLVD
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48040-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-388-9199
-----------------------------------------------------
Fax | 810-388-9176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1168 GRATIOT BLVD
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48040-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-388-9199
-----------------------------------------------------
Fax | 810-388-9176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KRISTINA SKELTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-388-9199
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 2301009838
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------