Provider Demographics
NPI:1174771570
Name:SUPERIOR HEALTH & WELLNESS
Entity type:Organization
Organization Name:SUPERIOR HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-758-7331
Mailing Address - Street 1:423N S LAKE MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:GULLIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49840-9038
Mailing Address - Country:US
Mailing Address - Phone:906-283-0203
Mailing Address - Fax:
Practice Address - Street 1:502 W HARRIE ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-1209
Practice Address - Country:US
Practice Address - Phone:906-293-9248
Practice Address - Fax:906-293-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty