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General NPI Number Information
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NPI Number | 1093848061
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Entity Type | Organization
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Legal Business Name | TRI COUNTY CHIROPRACTIC OF MICHIGAN INC.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4033 OWEN RD
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City | FENTON
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State | MI
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Zip | 48430-9100
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Country | US
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Telephone | 810-750-2600
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Fax | 810-750-6981
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Provider Business Mailing Address
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Address Line | 4033 OWEN RD
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City | FENTON
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State | MI
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Zip | 48430-9100
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Country | US
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Telephone | 810-750-2600
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Fax | 810-750-6981
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SCOTT KENNETH ANDERSON
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Credential | D.C.
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Telephone | 810-750-2600
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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 | 2301005414
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License Number State | MI
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