Healthcare Provider Details

I. General information

NPI: 1962250423
Provider Name (Legal Business Name): JAAFER ALDIRAWI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6558 GREENFIELD RD
DEARBORN MI
48126-1701
US

IV. Provider business mailing address

6558 GREENFIELD RD
DEARBORN MI
48126-1701
US

V. Phone/Fax

Practice location:
  • Phone: 313-757-9177
  • Fax:
Mailing address:
  • Phone: 313-757-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2301401521
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401521
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: