Organization
CUSTOM CHIROPRACTIC & WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON OLAFSSON DC (OWNER)
(248) 391-5400
Entity
Organization
Contact information
Practice address
3631 S BALDWIN RD, LAKE ORION, MI 48359-1506
(248) 391-5400
(248) 391-5404
Mailing address
3631 S BALDWIN RD, LAKE ORION, MI 48359-1506
(248) 391-5400
(248) 391-5404
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301009664
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
950F39332
BLUE CROSS BLUE SHIELD
MI
Enumeration date
09/28/2012
Last updated
06/20/2018
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