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General NPI Number Information
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NPI Number | 1083157184
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Entity Type | Organization
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Legal Business Name | MOTOR CITY MOBILE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 27209 LAHSER RD SUITE 225
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City | SOUTHFIELD
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State | MI
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Zip | 48034-8401
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Country | US
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Telephone | 248-537-4000
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Fax | 248-594-7775
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Provider Business Mailing Address
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Address Line | 27209 LAHSER RD SUITE 225
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City | SOUTHFIELD
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State | MI
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Zip | 48034-8401
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Country | US
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Telephone | 248-537-4000
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Fax | 248-594-7775
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. ASHLEA R. CLARK
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Credential | D.C.
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Telephone | 248-537-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2301010498
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License Number State | MI
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