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General NPI Number Information
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NPI Number | 1326589540
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Entity Type | Organization
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Legal Business Name | UTICA CHIROPRACTIC CLINIC OF MICHIGAN, PC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 45200 STERRITT ST SUITE 102
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City | UTICA
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State | MI
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Zip | 48317-5844
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Country | US
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Telephone | 586-739-6080
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Fax | 248-739-2797
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Provider Business Mailing Address
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Address Line | 45200 STERRITT ST SUITE 102
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City | UTICA
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State | MI
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Zip | 48317-5844
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Country | US
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Telephone | 586-739-6080
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Fax | 248-739-2797
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK DANIEL COHEN
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Credential | D.C.
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Telephone | 248-672-3443
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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 | 2301010463
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License Number State | MI
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