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General NPI Number Information
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NPI Number | 1548638174
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Entity Type | Individual
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Provider Name | ALYSSA MARIE ENGSTROM D.C.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 39802 VILLAGE WOOD CIR
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City | NOVI
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State | MI
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Zip | 48375
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Country | US
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Telephone | 248-719-1254
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Fax |
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Provider Business Mailing Address
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Address Line | 39802 VILLAGE WOOD CIR
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City | NOVI
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State | MI
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Zip | 48375
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Country | US
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Telephone | 248-719-1254
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2301010205
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License Number State | MI
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