Provider Demographics
NPI:1053630111
Name:SUPERIOR HEALTH AND WELLNESS PLLC
Entity type:Organization
Organization Name:SUPERIOR HEALTH AND WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HIESHETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-291-5080
Mailing Address - Street 1:423 N. LAKE MICHIGAN RD.
Mailing Address - Street 2:
Mailing Address - City:GULLIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49840
Mailing Address - Country:US
Mailing Address - Phone:906-291-5080
Mailing Address - Fax:906-291-5081
Practice Address - Street 1:207 W JOHN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-1126
Practice Address - Country:US
Practice Address - Phone:906-291-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P62830OtherMEDICARE PTAN