Organization
BACK TO HEALTH CHIROPRACTIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE DOMENICK DC (OWNER)
(810) 636-2190
Entity
Organization
Contact information
Practice address
9037 S STATE RD, GOODRICH, MI 48438-8869
(810) 636-2190
(810) 636-7855
Mailing address
9037 S STATE RD, GOODRICH, MI 48438-8869
(810) 636-2190
(810) 636-7855
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301008818
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0999848
HEALTH PLUS
MI
Enumeration date
11/14/2007
Last updated
11/14/2007
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