Healthcare Provider Details

I. General information

NPI: 1730942376
Provider Name (Legal Business Name): KM CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5958 N CANTON CENTER RD STE 300
CANTON MI
48187-2766
US

IV. Provider business mailing address

5958 N CANTON CENTER RD STE 300
CANTON MI
48187-2766
US

V. Phone/Fax

Practice location:
  • Phone: 734-212-5828
  • Fax: 734-212-5827
Mailing address:
  • Phone: 734-709-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: KRIS MERCADO
Title or Position: OWNER
Credential: DC, LAC
Phone: 734-212-5828