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General NPI Number Information
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NPI Number | 1639317514
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Entity Type | Organization
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Legal Business Name | THRIVE CHIROPRACTIC DEXTER P.C.
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 3219 BROAD ST SUITE 106
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City | DEXTER
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State | MI
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Zip | 48130
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Country | US
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Telephone | 734-253-2114
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Fax |
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Provider Business Mailing Address
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Address Line | 3219 BROAD ST. SUITE 106
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City | DEXTER
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State | MI
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Zip | 48130
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Country | US
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Telephone | 734-253-2114
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Fax | 734-253-2132
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER SIMPSON
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Credential | D.C.
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Telephone | 734-253-2114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 2301008768
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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 |
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License Number State |
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