Healthcare Provider Details

I. General information

NPI: 1770269318
Provider Name (Legal Business Name): MARY POTH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S LIVERNOIS RD STE C-14
ROCHESTER HILLS MI
48307-2582
US

IV. Provider business mailing address

455 S LIVERNOIS RD STE C-14
ROCHESTER HILLS MI
48307-2582
US

V. Phone/Fax

Practice location:
  • Phone: 248-963-2904
  • Fax: 248-710-3053
Mailing address:
  • Phone: 248-963-2904
  • Fax: 248-710-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401632
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: