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General NPI Number Information
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NPI Number | 1174831556
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Entity Type | Individual
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Provider Name | KEVIN MICHAEL MICHALAK D.C
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Gender | Male
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Dates
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Enumeration Date | 09/19/2010
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 8685 W GRAND RIVER AVE
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City | BRIGHTON
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State | MI
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Zip | 48116-2328
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Country | US
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Telephone | 810-225-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 8336 HILTON RD STE 100
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City | BRIGHTON
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State | MI
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Zip | 48114-5015
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Country | US
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Telephone | 810-225-2288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2301009808
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License Number State | MI
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