Provider Demographics
NPI:1871790162
Name:COMPREHENSIVE CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:COMPREHENSIVE CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-717-4311
Mailing Address - Street 1:21500 GREENFIELD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3009
Mailing Address - Country:US
Mailing Address - Phone:313-717-4311
Mailing Address - Fax:
Practice Address - Street 1:801 VIRGINIA PARK ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1925
Practice Address - Country:US
Practice Address - Phone:313-717-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q25142Medicare ID - Type Unspecified