Provider Demographics
NPI:1386969459
Name:COLDWATER CHIROPRACTIC & WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:COLDWATER CHIROPRACTIC & WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-278-2519
Mailing Address - Street 1:408 FOX RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-9483
Mailing Address - Country:US
Mailing Address - Phone:517-278-2519
Mailing Address - Fax:
Practice Address - Street 1:173 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1703
Practice Address - Country:US
Practice Address - Phone:517-278-2519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2024-09-10
Deactivation Date:2023-01-20
Deactivation Code:
Reactivation Date:2023-02-06
Provider Licenses
StateLicense IDTaxonomies
MI2301009654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU99196Medicare UPIN
VA004167C60Medicare PIN