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General NPI Number Information
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NPI Number | 1366539504
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Entity Type | Organization
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Legal Business Name | HOLISTIC CHIROPRACTIC CORP
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 670 GRISWOLD ST STE 200
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City | NORTHVILLE
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State | MI
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Zip | 48167-2687
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Country | US
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Telephone | 248-912-0075
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Fax |
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Provider Business Mailing Address
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Address Line | 18885 STONEWATER BLVD
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City | NORTHVILLE
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State | MI
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Zip | 48168-8557
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Country | US
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Telephone | 248-912-0075
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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. SUBY JACOB THOMAS
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Credential | D.C.
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Telephone | 248-912-0075
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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 | 2301008561
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License Number State | MI
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