Healthcare Provider Details

I. General information

NPI: 1134281561
Provider Name (Legal Business Name): OBRIEN CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 W SAINT CLAIR ST
ROMEO MI
48065-4657
US

IV. Provider business mailing address

143 W SAINT CLAIR ST
ROMEO MI
48065-4657
US

V. Phone/Fax

Practice location:
  • Phone: 586-752-1515
  • Fax: 586-752-4211
Mailing address:
  • Phone: 586-752-1515
  • Fax: 586-752-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005638
License Number StateMI

VIII. Authorized Official

Name: DR. MATTHEW PATRICK OBRIEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 586-752-1515