=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588822746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARBOR PARK CHIROPRACTIC WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2008
-----------------------------------------------------
Last Update Date | 05/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4940 W CLARK RD SUITE 101
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-0860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-434-8881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4940 W CLARK RD SUITE 101
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-0860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-434-8881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. RICHARD B OMEL JR.
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 734-434-8881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301008452
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------