Healthcare Provider Details

I. General information

NPI: 1699120774
Provider Name (Legal Business Name): URGENT CHIROPRACTIC CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30827 HOOVER RD
WARREN MI
48093-6539
US

IV. Provider business mailing address

30827 HOOVER RD
WARREN MI
48093-6539
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-8984
  • Fax: 586-751-5221
Mailing address:
  • Phone: 586-751-8984
  • Fax: 586-751-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007399
License Number StateMI

VIII. Authorized Official

Name: DEMERIUS WARE
Title or Position: DIRECTOR
Credential: D.C.
Phone: 586-751-8984