Healthcare Provider Details

I. General information

NPI: 1861746646
Provider Name (Legal Business Name): CHIROPRACTIC CENTER OF OAK PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 W 9 MILE RD SUITE A
OAK PARK MI
48237-2914
US

IV. Provider business mailing address

10450 W 9 MILE RD SUITE A
OAK PARK MI
48237-2914
US

V. Phone/Fax

Practice location:
  • Phone: 248-291-6360
  • Fax: 248-291-6453
Mailing address:
  • Phone: 313-563-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CANDICE AMANDA KAYAL
Title or Position: BILLER
Credential:
Phone: 313-563-3220