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General NPI Number Information
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NPI Number | 1881821486
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Entity Type | Organization
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Legal Business Name | HURON WELLNESS PROFESSIONAL LIMITED
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 718 GRISWOLD ST
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City | PORT HURON
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State | MI
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Zip | 48060-5847
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Country | US
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Telephone | 810-824-4995
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Fax | 810-824-4998
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Provider Business Mailing Address
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Address Line | 718 GRISWOLD ST
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City | PORT HURON
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State | MI
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Zip | 48060-5847
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Country | US
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Telephone | 810-824-4995
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Fax | 810-824-4998
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT ALBERT
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Credential | D.C.
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Telephone | 810-284-4995
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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 | 2301009565
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License Number State | MI
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