Organization
LIFE CYCLE FAMILY CHIROPRACTIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES MATTHEW WAGNER D.C. (OWNER)
(734) 439-0100
Entity
Organization
Contact information
Practice address
1162 DEXTER ST, MILAN, MI 48160-1162
(734) 439-0100
(734) 439-7701
Mailing address
1162 DEXTER ST, MILAN, MI 48160-1162
(734) 439-0100
(734) 439-7701
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301008349
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12317
MCARE
MI
01
—
95-0-H1-1336-0
BCBS
MI
01
—
OH 13360
BCN
MI
Enumeration date
02/09/2007
Last updated
01/25/2012
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