Provider Demographics
NPI:1508670274
Name:WANDER CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:WANDER CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAINA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROADSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-282-1881
Mailing Address - Street 1:215 W CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-2019
Mailing Address - Country:US
Mailing Address - Phone:989-282-1881
Mailing Address - Fax:
Practice Address - Street 1:215 W CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-2019
Practice Address - Country:US
Practice Address - Phone:989-282-1881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty