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General NPI Number Information
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NPI Number | 1306901137
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Entity Type | Organization
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Legal Business Name | WYOMING CHIROPRACTIC HEALTH CLINIC,P.C.
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7601 WYOMING ST
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City | DEARBORN
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State | MI
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Zip | 48126-1638
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Country | US
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Telephone | 313-933-1256
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Fax | 313-933-2252
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Provider Business Mailing Address
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Address Line | 5838 KENILWORTH ST
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City | DEARBORN
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State | MI
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Zip | 48126-2153
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Country | US
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Telephone | 313-581-5786
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Fax | 313-933-2252
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HASSAN MOHAMAD REICHOUNI
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Credential | D.C.
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Telephone | 313-933-1256
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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 | 2301008359
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License Number State | MI
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