Provider Demographics
NPI:1023727229
Name:DIVINE SPINE CHIROPRACTIC WELLNESS CENTER PLC
Entity type:Organization
Organization Name:DIVINE SPINE CHIROPRACTIC WELLNESS CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-487-2225
Mailing Address - Street 1:1103 TROWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5221
Mailing Address - Country:US
Mailing Address - Phone:517-487-2225
Mailing Address - Fax:517-487-4474
Practice Address - Street 1:1103 TROWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5221
Practice Address - Country:US
Practice Address - Phone:517-487-2225
Practice Address - Fax:517-487-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty