Provider Demographics
NPI:1295134559
Name:WILLIAMSTON WELLNESS PLLC
Entity type:Organization
Organization Name:WILLIAMSTON WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:RANES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-655-4234
Mailing Address - Street 1:1235 E GRAND RIVER RD
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-8303
Mailing Address - Country:US
Mailing Address - Phone:517-655-4234
Mailing Address - Fax:
Practice Address - Street 1:1235 E GRAND RIVER RD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-8303
Practice Address - Country:US
Practice Address - Phone:517-655-4234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty