Healthcare Provider Details

I. General information

NPI: 1386264257
Provider Name (Legal Business Name): NICHOLAS KEPREOS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48710 VAN DYKE AVE
SHELBY TWP MI
48317-2561
US

IV. Provider business mailing address

48710 VAN DYKE AVE
SHELBY TWP MI
48317-2561
US

V. Phone/Fax

Practice location:
  • Phone: 586-799-2010
  • Fax: 586-799-2011
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010945
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: