Provider Demographics
NPI:1538600697
Name:WELLNESS ROOTS CHIROPRACTIC & NUTRITION CENTER PLLC
Entity type:Organization
Organization Name:WELLNESS ROOTS CHIROPRACTIC & NUTRITION CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EISELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-369-9990
Mailing Address - Street 1:6360 JACKSON RD
Mailing Address - Street 2:STE F
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:734-369-9990
Mailing Address - Fax:734-661-0784
Practice Address - Street 1:6360 JACKSON RD
Practice Address - Street 2:STE F
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103
Practice Address - Country:US
Practice Address - Phone:734-369-9990
Practice Address - Fax:734-661-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty