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General NPI Number Information
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NPI Number | 1861813552
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Entity Type | Organization
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Legal Business Name | WOODLAND FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 3682 29TH ST SE SUITE A
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City | KENTWOOD
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State | MI
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Zip | 49512-1812
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Country | US
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Telephone | 616-822-9799
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Fax |
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Provider Business Mailing Address
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Address Line | 3682 29TH ST SE SUITE A
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City | KENTWOOD
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State | MI
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Zip | 49512-1812
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Country | US
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Telephone | 616-822-9799
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT CAESAR BELMONTE II
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Credential |
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Telephone | 616-822-9799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2301010090
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License Number State | MI
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