Healthcare Provider Details

I. General information

NPI: 1770841363
Provider Name (Legal Business Name): KATHERINE DIANE EISELE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 JACKSON RD STE F
ANN ARBOR MI
48103-9597
US

IV. Provider business mailing address

6360 JACKSON RD STE F
ANN ARBOR MI
48103-9597
US

V. Phone/Fax

Practice location:
  • Phone: 734-369-9990
  • Fax: 734-661-0784
Mailing address:
  • Phone: 734-369-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2301009904
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009904
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: