Healthcare Provider Details

I. General information

NPI: 1033878038
Provider Name (Legal Business Name): GREATLAKES CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 METRO PKWY STE 101
STERLING HEIGHTS MI
48310-7503
US

IV. Provider business mailing address

4105 METRO PKWY STE 101
STERLING HEIGHTS MI
48310-7503
US

V. Phone/Fax

Practice location:
  • Phone: 586-939-1003
  • Fax: 586-939-3862
Mailing address:
  • Phone: 586-939-1003
  • Fax: 586-939-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH ESTRADA
Title or Position: OWNER
Credential: DC
Phone: 586-939-1003