Provider Demographics
NPI:1700572146
Name:WEST SIDE CHIROPRACTIC AND WELLNESS, PLLC
Entity type:Organization
Organization Name:WEST SIDE CHIROPRACTIC AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-459-7180
Mailing Address - Street 1:5787 STADIUM DR STE B
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1903
Mailing Address - Country:US
Mailing Address - Phone:269-459-7180
Mailing Address - Fax:269-215-2004
Practice Address - Street 1:5787 STADIUM DR STE B
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1903
Practice Address - Country:US
Practice Address - Phone:269-459-7180
Practice Address - Fax:269-215-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty