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General NPI Number Information
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NPI Number | 1588090732
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Entity Type | Organization
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Legal Business Name | DYNAMIC CHIROPRACTIC CENTERS
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 02/22/2014
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Provider Practice Location Address
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Address Line | 555 BARCLAY CIR STE 140
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4555
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Country | US
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Telephone | 248-299-6911
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Fax | 248-299-6915
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Provider Business Mailing Address
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Address Line | 555 BARCLAY CIR STE 140
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4555
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Country | US
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Telephone | 248-299-6911
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Fax | 248-299-6915
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Authorized Official
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Title or Position | DC/OWNER
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Name | DR. ONDRE JACQUES
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Credential | DC
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Telephone | 248-299-6911
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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 | 2301008019
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License Number State | MI
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