Provider Demographics
NPI:1194613448
Name:ORIGINS COMMUNITY WELLNESS CENTER
Entity type:Organization
Organization Name:ORIGINS COMMUNITY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHEYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-916-7429
Mailing Address - Street 1:6842 OLD VILLAGE CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6801
Mailing Address - Country:US
Mailing Address - Phone:616-916-7429
Mailing Address - Fax:
Practice Address - Street 1:4004 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4215
Practice Address - Country:US
Practice Address - Phone:517-327-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty