Provider Demographics
NPI:1386742245
Name:SAKS WELLNESS CENTER P.C.
Entity type:Organization
Organization Name:SAKS WELLNESS CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-732-7000
Mailing Address - Street 1:PO BOX 1488
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49734-5488
Mailing Address - Country:US
Mailing Address - Phone:989-732-7000
Mailing Address - Fax:989-732-4271
Practice Address - Street 1:1447 S OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-7739
Practice Address - Country:US
Practice Address - Phone:989-732-7000
Practice Address - Fax:989-732-4271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F96006OtherBLUE CROSS
MI0F96006Medicare ID - Type Unspecified