Healthcare Provider Details

I. General information

NPI: 1639317514
Provider Name (Legal Business Name): THRIVE CHIROPRACTIC DEXTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 BROAD ST SUITE 106
DEXTER MI
48130
US

IV. Provider business mailing address

3219 BROAD ST. SUITE 106
DEXTER MI
48130
US

V. Phone/Fax

Practice location:
  • Phone: 734-253-2114
  • Fax:
Mailing address:
  • Phone: 734-253-2114
  • Fax: 734-253-2132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number2301008768
License Number StateMI

VIII. Authorized Official

Name: DR. JENNIFER SIMPSON
Title or Position: OWNER
Credential: D.C.
Phone: 734-253-2114