| Organization Name: | FAMILY WELLNESS PRACTICE PLLC |
| NPI Number: | 1235497884 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BERNARD FOSTER (OWNER) |
| Mailing Address: | 21261 Kelly Rd Eastpointe |
| State: | MI US |
| Postal Code: | 480213125 |
| Phone Number: | 5869440085 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2012 |
| NPI Last Update Date: | 10/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP3300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Pain |
| Taxonomy Definition: | |