Healthcare Provider Details

I. General information

NPI: 1225222730
Provider Name (Legal Business Name): MICHIGAN SPINE & JOINT CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32500 23 MILE RD
CHESTERFIELD MI
48047-1991
US

IV. Provider business mailing address

32500 23 MILE RD
CHESTERFIELD MI
48047-1991
US

V. Phone/Fax

Practice location:
  • Phone: 158-672-5310
  • Fax: 158-672-5315
Mailing address:
  • Phone: 158-672-5310
  • Fax: 158-672-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS NEUNER
Title or Position: OWNER
Credential: DC
Phone: 586-725-3100