Healthcare Provider Details

I. General information

NPI: 1558559799
Provider Name (Legal Business Name): EISMAN CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17401 GREENFIELD RD
DETROIT MI
48235-3700
US

IV. Provider business mailing address

17401 GREENFIELD RD
DETROIT MI
48235-3700
US

V. Phone/Fax

Practice location:
  • Phone: 313-837-3300
  • Fax:
Mailing address:
  • Phone: 313-837-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2301004022
License Number StateMI

VIII. Authorized Official

Name: DR. JEFFREY L EISMAN
Title or Position: PRESIDENT
Credential: DC
Phone: 313-837-3300