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General NPI Number Information
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NPI Number | 1053455618
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CARE CENTER INC.
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 1881 N PONTIAC TRL SUITE B
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City | WALLED LAKE
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State | MI
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Zip | 48390-3101
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Country | US
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Telephone | 248-926-0455
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Fax |
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Provider Business Mailing Address
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Address Line | 1881 N PONTIAC TRL SUITE B
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City | WALLED LAKE
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State | MI
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Zip | 48390-3101
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Country | US
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Telephone | 248-926-0455
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TOM SLADIC
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Credential | DC
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Telephone | 248-926-0455
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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 | 2301007531
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License Number State | MI
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