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General NPI Number Information
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NPI Number | 1629124326
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Entity Type | Organization
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Legal Business Name | LOGAN CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 27104 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48092-3537
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Country | US
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Telephone | 586-751-1977
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Fax | 586-751-1929
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Provider Business Mailing Address
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Address Line | 27104 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48092-3537
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Country | US
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Telephone | 586-751-1977
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Fax | 586-751-1929
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Authorized Official
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Title or Position | OWNER
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Name | DR. BILL ALAN LOGAN
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Credential | D.C
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Telephone | 586-751-1977
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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 | CS008620
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | BL005438
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License Number State | MI
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