Provider Demographics
NPI:1295925295
Name:EXPRESS YOUR HEALTH LLC
Entity type:Organization
Organization Name:EXPRESS YOUR HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-324-5000
Mailing Address - Street 1:8175 CREEKSIDE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5370
Mailing Address - Country:US
Mailing Address - Phone:269-324-5000
Mailing Address - Fax:269-324-5822
Practice Address - Street 1:8175 CREEKSIDE DR STE 110
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5370
Practice Address - Country:US
Practice Address - Phone:269-324-5000
Practice Address - Fax:269-324-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C913900OtherBLUE CROSS MI
MIU87379Medicare UPIN
MI0P23140Medicare PIN