Healthcare Provider Details

I. General information

NPI: 1447446356
Provider Name (Legal Business Name): MAIN STREET CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22919 W MAIN ST
ARMADA MI
48005-4708
US

IV. Provider business mailing address

PO BOX 368
ARMADA MI
48005-0368
US

V. Phone/Fax

Practice location:
  • Phone: 586-784-5470
  • Fax:
Mailing address:
  • Phone: 586-784-5470
  • Fax: 586-784-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2301009194
License Number StateMI

VIII. Authorized Official

Name: JULIE K RAWLINGS
Title or Position: OWNER
Credential: DC
Phone: 586-784-5470