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General NPI Number Information
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NPI Number | 1255505160
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Entity Type | Organization
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Legal Business Name | GREAT LAKES ADMINISTRATIVE SERVICES LLC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 1645 S WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48186-5621
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Country | US
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Telephone | 734-728-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 36500 FORD RD # 159
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City | WESTLAND
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State | MI
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Zip | 48185-3769
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA ARIAS
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Credential |
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Telephone | 734-728-7246
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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 |
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License Number State |
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