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General NPI Number Information
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NPI Number | 1023575586
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Entity Type | Organization
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Legal Business Name | MOSURAK CHIROPRACTIC & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 6201 CHICAGO RD
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City | WARREN
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State | MI
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Zip | 48092-4755
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Country | US
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Telephone | 586-264-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 4275 GRATIOT AVE
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3900
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. LAWRENCE MOSURAK III
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Credential | DC
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Telephone | 810-459-9144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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