Provider Demographics
NPI:1831579671
Name:LUCEY CHIROPRACTIC AND WELLNESS CENTER
Entity type:Organization
Organization Name:LUCEY CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-390-5799
Mailing Address - Street 1:6504 28TH ST SE
Mailing Address - Street 2:SUITE H
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6959
Mailing Address - Country:US
Mailing Address - Phone:989-390-5799
Mailing Address - Fax:616-228-8778
Practice Address - Street 1:6504 28TH ST SE
Practice Address - Street 2:SUITE H
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6959
Practice Address - Country:US
Practice Address - Phone:989-390-5799
Practice Address - Fax:616-228-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-07
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty