MEDICARE: PRO CHIROPRACTIC PLLC

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	2301005895	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518967298	OTHER	AZ	BCBS
2	95-0-F3-2959-0	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1881920718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 220
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48012-0220
Country	:	US
Telephone Number	:	480-284-9072
Fax Number	:

Provider Business Practice Location Address
First Line	:	536 N OLD WOODWARD AVE
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-5375
Country	:	US
Telephone Number	:	248-792-9736
Fax Number	:

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. RAYMOND JAMES HLLENBRAND
Credential	:	DC
Telephone Number	:	480-284-9072

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	12/31/2009

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