MEDICARE: CONNECT CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	230101652	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487145801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECT CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	6177 LAKE MICHIGAN DR
Second Line	:
City	:	ALLENDALE
State	:	MI
Zip	:	49401-9244
Country	:	US
Telephone Number	:	616-379-3932
Fax Number	:	616-379-9329

Provider Business Practice Location Address
First Line	:	6177 LAKE MICHIGAN DR
Second Line	:
City	:	ALLENDALE
State	:	MI
Zip	:	49401-9244
Country	:	US
Telephone Number	:	616-379-3932
Fax Number	:	616-379-9329

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	BLAIR ANN-BRESLIN WOLFERT
Credential	:	DC
Telephone Number	:	616-379-9329

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	05/26/2026

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Directions to “CONNECT CHIROPRACTIC LLC ” Practice Location

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