Healthcare Provider Details

I. General information

NPI: 1871822650
Provider Name (Legal Business Name): ELIZABETH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SINCLAIR ST SUITE A
SAINT CLAIR MI
48079-5905
US

IV. Provider business mailing address

1820 SINCLAIR ST SUITE A
SAINT CLAIR MI
48079-5905
US

V. Phone/Fax

Practice location:
  • Phone: 810-329-9900
  • Fax: 810-329-0900
Mailing address:
  • Phone: 810-329-9900
  • Fax: 810-329-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberEB006923
License Number StateMI

VIII. Authorized Official

Name: MRS. VIVIAN ROMZEK
Title or Position: CHIROPRACTIC ASSISTANT
Credential:
Phone: 810-329-9900