Healthcare Provider Details

I. General information

NPI: 1598856874
Provider Name (Legal Business Name): PROSPER FAMILY CHIROPRACTIC CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 ROCHESTER RD
ROYAL OAK MI
48073-2729
US

IV. Provider business mailing address

4203 ROCHESTER RD
ROYAL OAK MI
48073-2729
US

V. Phone/Fax

Practice location:
  • Phone: 248-616-0900
  • Fax: 248-616-1911
Mailing address:
  • Phone: 248-616-0900
  • Fax: 248-616-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008509
License Number StateMI

VIII. Authorized Official

Name: DR. CHRISTIE J PROSPER
Title or Position: DR. OF CHIROPRACTIC
Credential: DC
Phone: 248-616-0900