Healthcare Provider Details

I. General information

NPI: 1568609246
Provider Name (Legal Business Name): SHAHID ALI KHAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMMAD SHAHID KHAN D.C.

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27850 GRATIOT AVE
ROSEVILLE MI
48066-4803
US

IV. Provider business mailing address

27850 GRATIOT AVE
ROSEVILLE MI
48066-4803
US

V. Phone/Fax

Practice location:
  • Phone: 586-772-5876
  • Fax: 586-772-1122
Mailing address:
  • Phone: 586-772-5876
  • Fax: 586-772-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009421
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2301009421
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number2301009421
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2301009421
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number2301009421
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2301009421
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: