Healthcare Provider Details

I. General information

NPI: 1265784763
Provider Name (Legal Business Name): AK CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 N LAPEER RD BLDG 1 SUITE B
NORTH BRANCH MI
48461-9660
US

IV. Provider business mailing address

5830 N LAPEER RD BLDG 1 SUITE B
NORTH BRANCH MI
48461-9660
US

V. Phone/Fax

Practice location:
  • Phone: 810-793-7376
  • Fax: 810-793-7647
Mailing address:
  • Phone: 810-793-7376
  • Fax: 810-793-7647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANTOINETTE M KOTCHOUNIAN
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 810-793-7376