Healthcare Provider Details

I. General information

NPI: 1467758466
Provider Name (Legal Business Name): CLINTON TOWNSHIP CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41060 HAYES RD
CLINTON TOWNSHIP MI
48038-5869
US

IV. Provider business mailing address

41060 HAYES RD
CLINTON TOWNSHIP MI
48038-5869
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC005167
License Number StateMI

VIII. Authorized Official

Name: MR. DANIEL CLARK
Title or Position: OWNER
Credential: DC
Phone: 586-228-1500