MEDICARE: NORTH STAR SPINE AND WELLNESS 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

General Provider Information

NPI Number	:	1770317729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STAR SPINE AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1235 CHESTER RD
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-4808
Country	:	US
Telephone Number	:	517-507-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	2824 E GRAND RIVER AVE STE C
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-4342
Country	:	US
Telephone Number	:	517-507-9777
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC, CLINIC OWNE
Name	:	KAMYAB KAMALI
Credential	:	DC
Telephone Number	:	517-507-9777

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	12/26/2024

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Directions to “NORTH STAR SPINE AND WELLNESS LLC ” Practice Location

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