Healthcare Provider Details

I. General information

NPI: 1871668400
Provider Name (Legal Business Name): BACK IN LINE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 E. 9 MILE RD
HAZEL PARK MI
48030
US

IV. Provider business mailing address

PO BOX 365
HAZEL PARK MI
48030-0365
US

V. Phone/Fax

Practice location:
  • Phone: 248-556-5890
  • Fax: 248-556-5891
Mailing address:
  • Phone: 313-768-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008526
License Number StateMI

VIII. Authorized Official

Name: DR. MOHAMED SALEH
Title or Position: OWNER
Credential: D.C.
Phone: 313-768-8858