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General NPI Number Information
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NPI Number | 1205012523
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Entity Type | Organization
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Legal Business Name | DESIRA CHIROPRACTIC LIFE CENTER LLC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 33250 WARREN RD
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City | WESTLAND
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State | MI
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Zip | 48185-2920
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Country | US
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Telephone | 734-422-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 33250 WARREN RD
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City | WESTLAND
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State | MI
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Zip | 48185-2920
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Country | US
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Telephone | 734-422-7800
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. RICHARD GERARD DESIRA
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Credential | DC
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Telephone | 734-422-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2301005025
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License Number State | MI
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