Healthcare Provider Details

I. General information

NPI: 1982716676
Provider Name (Legal Business Name): DETROIT INJURY AND PAIN CENTERS , PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 GRATIOT AVE
DETROIT MI
48213-2816
US

IV. Provider business mailing address

7200 GRATIOT AVE DETROIT INJURY AND PAIN CENTERS, PLLC
DETROIT MI
48213-2816
US

V. Phone/Fax

Practice location:
  • Phone: 313-579-3472
  • Fax: 313-579-1388
Mailing address:
  • Phone: 313-579-3472
  • Fax: 313-579-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number2301007399
License Number StateMI

VIII. Authorized Official

Name: DR. DEMERIUS L WARE
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 313-579-3472