Basic Information
| Provider Information | |||||||||
| NPI: | 1942421656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAURIUM WELLNESS CENTER, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 HECLA ST | ||||||||
| Address2: | |||||||||
| City: | LAURIUM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499132128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063379355 | ||||||||
| FaxNumber: | 9063374788 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 HECLA ST | ||||||||
| Address2: | |||||||||
| City: | LAURIUM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499132128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063379355 | ||||||||
| FaxNumber: | 9063374788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 09/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | HAFEMAN | ||||||||
| AuthorizedOfficialFirstName: | BONNIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9063379355 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.