| NPI | 1023298403 |
|---|---|
| Former Legal Business Name | PHOENIX WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | CHARLES HOWARD LANGE President 231-938-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor Nutrition (Licence: MI 2301007576) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2011-06-20 |