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General NPI Number Information
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NPI Number | 1225273592
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Entity Type | Organization
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Legal Business Name | COMMUNITY CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 548 S MAIN ST
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City | ANN ARBOR
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State | MI
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Zip | 48104-2921
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Country | US
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Telephone | 734-995-9777
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Fax | 734-663-1255
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Provider Business Mailing Address
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Address Line | 548 S MAIN ST
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City | ANN ARBOR
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State | MI
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Zip | 48104-2921
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Country | US
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Telephone | 734-995-9777
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Fax | 734-663-1255
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Authorized Official
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Title or Position | SOLE MBR
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Name | MARK T SAKALAUSKAS
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Credential | D.C.
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Telephone | 734-995-9777
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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 | 2301004556
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License Number State | MI
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