East West Life Solutions Inc.
Organization Active NPI Chiropractor · Clio, MI
NPI 1104337211 · NPPES record last updated Oct 16, 2017
Key facts
- NPI
- 1104337211
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2301009759 (MI)
- Legal business name
- EAST WEST LIFE SOLUTIONS INC.
- Practice address
- 221 S Mill St
Clio, MI 48420-2324 - Phone
- (810) 522-3095
- NPI assigned
- Oct 16, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Lambros Nicholas Kottalis, DC
- Title
- Ceo
- Phone
- (810) 522-3095
Practitioners 1
-
Lambros N Kottalis, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180104001928 | MI | Part B Supplier - Clinic/Group Practice | 8820357445 |
Receives reassigned benefits from 1 practitioner Practice locations: Flushing, MI |
National Provider Directory
Locations
221 S Mill St
Clio, MI 48420
Phone (810) 522-3095
221 S Mill St
Ste 3
Clio, MI 48420
Phone (810) 547-7111
3280 N Elms Rd
Ste 4
Flushing, MI 48433
Phone (810) 659-9700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2301009759 | MI | Yes |
Addresses
Primary practice location
221 S Mill St
Clio, MI 48420-2324
Mailing address
14543 Blue Heron Dr
Fenton, MI 48430-3268
Phone (810) 522-3095
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134421019 | Medicaid | MI |
Other providers in Clio, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.