Healthcare Provider Details

I. General information

NPI: 1649033226
Provider Name (Legal Business Name): RESTORE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 PERRY RD
GRAND BLANC MI
48439-1483
US

IV. Provider business mailing address

536 PERRY RD
GRAND BLANC MI
48439-1483
US

V. Phone/Fax

Practice location:
  • Phone: 810-498-4738
  • Fax: 248-254-7462
Mailing address:
  • Phone: 810-498-4738
  • Fax: 248-254-7462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: KEITH RANDALL DENNING
Title or Position: OWNER, DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 248-933-3286