Healthcare Provider Details

I. General information

NPI: 1962650903
Provider Name (Legal Business Name): DALE J KRETUNSKI DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16224 E 13 MILE RD
ROSEVILLE MI
48066-1524
US

IV. Provider business mailing address

16224 E 13 MILE RD
ROSEVILLE MI
48066-1524
US

V. Phone/Fax

Practice location:
  • Phone: 586-773-9530
  • Fax: 586-773-7765
Mailing address:
  • Phone: 586-773-9530
  • Fax: 586-773-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301004970
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501002214
License Number StateMI

VIII. Authorized Official

Name: DR. DALE JOSEPH KRETUNSKI
Title or Position: OWNER
Credential: D.C., P.T.
Phone: 586-773-9530