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General NPI Number Information
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NPI Number | 1518072776
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Entity Type | Organization
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Legal Business Name | PLYMOUTH CHIROPRACTIC WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 908 PENNIMAN AVE
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City | PLYMOUTH
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State | MI
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Zip | 48170-1624
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Country | US
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Telephone | 734-453-7090
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Fax | 734-453-9992
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Provider Business Mailing Address
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Address Line | 908 PENNIMAN AVE
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City | PLYMOUTH
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State | MI
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Zip | 48170-1624
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Country | US
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Telephone | 734-453-7090
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Fax | 734-453-9992
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH ANNE SISK
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Credential | DC
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Telephone | 734-459-7090
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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 | 2301006903
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License Number State | MI
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