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General NPI Number Information
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NPI Number | 1669663928
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Entity Type | Organization
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Legal Business Name | PAIN AND INJURY REHABILITATION CLINIC
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 28300 FRANKLIN RD STE A
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1657
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Country | US
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Telephone | 248-354-8180
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Fax | 248-354-8199
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Provider Business Mailing Address
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Address Line | 29193 NORTHWESTERN HWY # 521
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1011
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Country | US
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Telephone | 248-354-8180
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Fax | 248-354-8199
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RACHEL ANNE STADICK
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Credential | DC CMT
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Telephone | 248-354-8180
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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 | 2301009001
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License Number State | MI
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