Healthcare Provider Details

I. General information

NPI: 1154504694
Provider Name (Legal Business Name): COMMUNITY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W VERNOR HWY
DETROIT MI
48209-2180
US

IV. Provider business mailing address

5901 W VERNOR HWY
DETROIT MI
48209-2180
US

V. Phone/Fax

Practice location:
  • Phone: 313-554-4357
  • Fax: 313-554-1565
Mailing address:
  • Phone: 313-554-4357
  • Fax: 313-554-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number23010008454
License Number StateMI

VIII. Authorized Official

Name: DR. RASHAD SALEH
Title or Position: DIRECTOR
Credential: DC
Phone: 313-574-1191