MEDICARE: ESSENTIAL FAMILY CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301009803	MI

General Provider Information

NPI Number	:	1194095646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	33225 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48336-3123
Country	:	US
Telephone Number	:	248-767-8732
Fax Number	:	248-477-1052

Provider Business Practice Location Address
First Line	:	33225 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48336-3123
Country	:	US
Telephone Number	:	248-767-8732
Fax Number	:	248-477-1052

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. NATALIE MARIE NEDANOVSKI
Credential	:	D.C.
Telephone Number	:	248-767-8732

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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