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General NPI Number Information
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NPI Number | 1871790162
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CHIROPRACTIC WELLNESS CENTER
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 801 VIRGINIA PARK ST
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City | DETROIT
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State | MI
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Zip | 48202-1925
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Country | US
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Telephone | 313-717-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 21500 GREENFIELD RD STE 201
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City | OAK PARK
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State | MI
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Zip | 48237-3009
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Country | US
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Telephone | 313-717-4311
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM NELSON
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Credential | DC
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Telephone | 313-717-4311
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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 | 2301004743
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License Number State | MI
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