=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073198719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROCCO J BORG DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2021
-----------------------------------------------------
Last Update Date | 05/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 758 N STATE ST
-----------------------------------------------------
City | CARO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48723-1546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-672-4141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 N ORTONVILLE RD
-----------------------------------------------------
City | ORTONVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48462-8531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301011061
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------