Provider Demographics
NPI:1306313044
Name:PRO-ACTIVE CHIROPRACTIC & WELLNESS
Entity type:Organization
Organization Name:PRO-ACTIVE CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-625-7600
Mailing Address - Street 1:6507 TOWN CENTER DR STE F
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4826
Mailing Address - Country:US
Mailing Address - Phone:248-625-7600
Mailing Address - Fax:248-625-2772
Practice Address - Street 1:6507 TOWN CENTER DR STE F
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4826
Practice Address - Country:US
Practice Address - Phone:248-625-7600
Practice Address - Fax:616-288-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902155096OtherNPI 1
MI2301009883OtherLICENSE NUMBER