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General NPI Number Information
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NPI Number | 1346577582
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Entity Type | Organization
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Legal Business Name | JACK FAILLA D.C.P.C.
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 30045 HARPER AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1649
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Country | US
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Telephone | 586-772-8560
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Fax |
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Provider Business Mailing Address
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Address Line | 30045 HARPER AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1649
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Country | US
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Telephone | 586-772-8560
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK FAILLA
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Credential | D.C, P.C.
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Telephone | 586-772-8560
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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 | 2301001958
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License Number State | MI
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