Provider Demographics
NPI:1902552342
Name:TOTAL WELLNESS MI
Entity Type:Organization
Organization Name:TOTAL WELLNESS MI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEHAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-603-9596
Mailing Address - Street 1:8204 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2229
Mailing Address - Country:US
Mailing Address - Phone:313-603-9596
Mailing Address - Fax:
Practice Address - Street 1:8204 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-2229
Practice Address - Country:US
Practice Address - Phone:313-603-9596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1952602716Medicaid