Healthcare Provider Details

I. General information

NPI: 1295785467
Provider Name (Legal Business Name): CHRIS A NIEDZINSKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28345 BECK RD SUITE 412
WIXOM MI
48393-4733
US

IV. Provider business mailing address

42683 WIMBLETON WAY
NOVI MI
48377-2044
US

V. Phone/Fax

Practice location:
  • Phone: 248-349-0300
  • Fax: 248-349-0307
Mailing address:
  • Phone: 248-349-0300
  • Fax: 248-349-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008931
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: