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General NPI Number Information
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NPI Number | 1306217377
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Entity Type | Organization
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Legal Business Name | CLUGSTON CHIROPRACTIC CENTER, P.C.
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 33779 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-2850
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Country | US
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Telephone | 734-261-7590
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Fax |
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Provider Business Mailing Address
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Address Line | 33779 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-2850
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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/DOCTOR OF CHIROPRACTIC
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Name | WILLIAM CLUGSTON
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Credential |
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Telephone | 734-261-7590
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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 | 2301009925
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License Number State | MI
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